Provider Demographics
NPI:1124034889
Name:WEST CENTRAL MISSOURI ORTHOPAEDIC SURGICAL SERIVCES P.C.
Entity Type:Organization
Organization Name:WEST CENTRAL MISSOURI ORTHOPAEDIC SURGICAL SERIVCES P.C.
Other - Org Name:ORTHOPAEDIC SURGEONS
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:W
Authorized Official - Last Name:KIBURZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:660-826-5890
Mailing Address - Street 1:2301 S INGRAM AVE
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65301-8121
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2301 S INGRAM AVE
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-8121
Practice Address - Country:US
Practice Address - Phone:660-826-5890
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO509999207Medicaid
MOH990000Medicare PIN
MO509999207Medicaid