Organization
CURATORS UNIVERSITY OF MO
Active
Other names
DBA MISSOURI REHABILITATION CENTER-PHYSICIANS GROUP
Organization subpart
No
Provider details
NPI number
Authorized official
MITCHELL L WASDEN (CEO/COO)
(573) 884-8738
Entity
Organization
Contact information
Practice address
600 N MAIN ST, MOUNT VERNON, MO 65712-1004
(417) 461-5312
(417) 461-5765
Mailing address
600 N MAIN ST, MOUNT VERNON, MO 65712-1004
(417) 461-5312
(417) 461-5765
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
—
—
207RP1001X
Pulmonary Disease Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
—
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
—
—
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
550156103
—
MO
Enumeration date
03/15/2007
Last updated
01/14/2013
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