Provider Demographics
NPI:1225358641
Name:JOHN M. WARD, D.O., P.C.
Entity Type:Organization
Organization Name:JOHN M. WARD, D.O., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:660-882-2451
Mailing Address - Street 1:306 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BOONVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65233-1566
Mailing Address - Country:US
Mailing Address - Phone:660-882-2451
Mailing Address - Fax:660-882-2434
Practice Address - Street 1:306 MAIN ST
Practice Address - Street 2:
Practice Address - City:BOONVILLE
Practice Address - State:MO
Practice Address - Zip Code:65233-1566
Practice Address - Country:US
Practice Address - Phone:660-882-2451
Practice Address - Fax:660-882-2434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-08
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO31656208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO240091702Medicaid
MO240091702Medicaid