Provider Demographics
NPI:1245392133
Name:MCWHIRT-GIBSON INCORPORATION
Entity Type:Organization
Organization Name:MCWHIRT-GIBSON INCORPORATION
Other - Org Name:MEDICAL CENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:KNORP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-826-2626
Mailing Address - Street 1:1700 S INGRAM AVE
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65301-7536
Mailing Address - Country:US
Mailing Address - Phone:660-826-2626
Mailing Address - Fax:660-826-4329
Practice Address - Street 1:1700 S INGRAM AVE
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-7536
Practice Address - Country:US
Practice Address - Phone:660-826-2626
Practice Address - Fax:660-826-4329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0056153336C0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO600130009Medicaid