Provider Demographics
NPI:1467405035
Name:WESTERN JOHNSON COUNTY MEDICAL CLINIC
Entity Type:Organization
Organization Name:WESTERN JOHNSON COUNTY MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAYLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-597-3500
Mailing Address - Street 1:PO BOX 111
Mailing Address - Street 2:
Mailing Address - City:KINGSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64061-0111
Mailing Address - Country:US
Mailing Address - Phone:816-597-3500
Mailing Address - Fax:816-597-3555
Practice Address - Street 1:305 E PACIFIC ST
Practice Address - Street 2:
Practice Address - City:KINGSVILLE
Practice Address - State:MO
Practice Address - Zip Code:64061-2512
Practice Address - Country:US
Practice Address - Phone:816-597-3500
Practice Address - Fax:816-597-3555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center