Provider Demographics
NPI:1629173232
Name:RAYMOND H. WILBERS, INC.
Entity Type:Organization
Organization Name:RAYMOND H. WILBERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:H
Authorized Official - Last Name:WILBERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:573-581-2030
Mailing Address - Street 1:625 E SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:MEXICO
Mailing Address - State:MO
Mailing Address - Zip Code:65265-3294
Mailing Address - Country:US
Mailing Address - Phone:573-581-2030
Mailing Address - Fax:573-581-7675
Practice Address - Street 1:625 E SUMMIT ST
Practice Address - Street 2:
Practice Address - City:MEXICO
Practice Address - State:MO
Practice Address - Zip Code:65265-3294
Practice Address - Country:US
Practice Address - Phone:573-581-2030
Practice Address - Fax:573-581-7675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO500426200Medicaid
MOA13279Medicare UPIN
MO500426200Medicaid
MO263969Medicare Oscar/Certification