Provider Demographics
NPI:1912089160
Name:FAMILY PRACTICE ASSOCIATES OF WEST CENTRAL MISSOURI, PC
Entity Type:Organization
Organization Name:FAMILY PRACTICE ASSOCIATES OF WEST CENTRAL MISSOURI, PC
Other - Org Name:WARRENSBURG RURAL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:V
Authorized Official - Last Name:PULLIAM
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:660-584-7751
Mailing Address - Street 1:513 BURKARTH RD
Mailing Address - Street 2:
Mailing Address - City:WARRENSBURG
Mailing Address - State:MO
Mailing Address - Zip Code:64093-3103
Mailing Address - Country:US
Mailing Address - Phone:660-747-7750
Mailing Address - Fax:660-747-8398
Practice Address - Street 1:513 BURKARTH RD
Practice Address - Street 2:
Practice Address - City:WARRENSBURG
Practice Address - State:MO
Practice Address - Zip Code:64093-3103
Practice Address - Country:US
Practice Address - Phone:660-747-7751
Practice Address - Fax:660-747-8398
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY PRACTICE ASSOCIATES OF WEST CENTRAL MO PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-19
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO596851105Medicaid
MO263820Medicare Oscar/Certification