# WENTWORTH MILITARY ACADEMY AND JUNIOR COLLEGE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1669661393
- **Authorized official:** MR. MICHAEL WILLAIM LIERMAN (CHIEF OF STAFF)
- **Authorized official phone:** (660) 259-2221

## Contact information

- **Practice address:** 1880 WASHINGTON AVE, LEXINGTON, MO 64067-1708
- **Practice address phone:** (660) 259-2221
- **Practice address fax:** (660) 259-2677
- **Mailing address:** 1880 WASHINGTON AVE, LEXINGTON, MO 64067-1708
- **Mailing address phone:** (660) 259-2221
- **Mailing address fax:** (660) 259-2677

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 105321 | MO | Yes |

## Other

- **Enumeration date:** 10/18/2007
- **Last updated:** 10/18/2007