PCRMC MEDICAL GROUP INC NPI 1114235041

NPI Information

  • NPI: 1114235041
  • Provider Name: PCRMC MEDICAL GROUP, INC
  • Classification: Clinic/Center - 261QR1300X
  • Specialization: Rural Health
  • Entity Type: Organization
  • Doing Business As: PHELPS HEALTH MEDICAL GROUP VIENNA
  • CLIA Number: 26D1052781
  • Address: 606 HIGHWAY 63 S
    VIENNA, MO
    ZIP 65582
  • Phone: (573) 422-3636

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NPI Details

PCRMC MEDICAL GROUP, INC is a rural health clinic center in Vienna, MO. PCRMC MEDICAL GROUP, INC NPI is 1114235041. The provider is registered as an organization entity type.
The provider Is Doing Business As Phelps Health Medical Group Vienna.

The provider's business location address is:

606 HIGHWAY 63 S
VIENNA, MO
ZIP 65582-101
Phone: (573) 422-3636
Fax: (573) 422-3434

The provider's authorized official is Jana M Cook .
The authorized official title is Vp, Chief Financial Officer and has the following contact phone number (573) 458-7916.

The CLIA number assigned to this NPI record is 26D1052781 - rural health clinic with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/14/2010 and was last updated on 1/17/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QR1300XClinic/CenterRural Health2007024375MISSOURIYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1594328304MEDICAIDMISSOURI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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