Organization
WESTERN MISSOURI RADIOLOGICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBRA WILSON (PRACTICE MANAGER)
(816) 796-1412
Entity
Organization
Contact information
Practice address
19609 E 9TH ST S, INDEPENDENCE, MO 64056-3088
(816) 796-1412
Mailing address
19609 E 9TH ST S, INDEPENDENCE, MO 64056-3088
(816) 796-1412
(816) 796-3398
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
—
—
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100212500A
—
KS
05
—
711064709
—
MO
01
—
CG1954
RR MEDICARE
MO
01
—
CN9668
RR MEDICARE
MO
Enumeration date
12/21/2006
Last updated
07/02/2009
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