Provider Demographics
NPI:1720409113
Name:WESTERN MISSOURI MEDICAL CENTER
Entity Type:Organization
Organization Name:WESTERN MISSOURI MEDICAL CENTER
Other - Org Name:ST. LUKE'S CANCER INSTITUTE AT WMMC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP FINANCIAL SERVICES / CFO
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-262-7307
Mailing Address - Street 1:403 BURKARTH RD
Mailing Address - Street 2:
Mailing Address - City:WARRENSBURG
Mailing Address - State:MO
Mailing Address - Zip Code:64093-3101
Mailing Address - Country:US
Mailing Address - Phone:660-747-2500
Mailing Address - Fax:660-747-8455
Practice Address - Street 1:403 BURKARTH RD
Practice Address - Street 2:
Practice Address - City:WARRENSBURG
Practice Address - State:MO
Practice Address - Zip Code:64093-3101
Practice Address - Country:US
Practice Address - Phone:660-747-2500
Practice Address - Fax:660-747-8455
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WESTERN MISSOURI MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-01-02
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Single Specialty