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JEFFERSON CITY MEDICAL GROUP P.C. NPI 1336189398


NPI Information

NPI: 1336189398
Provider Name: JEFFERSON CITY MEDICAL GROUP, P.C.
Classification: Clinic/Center - 261QM1300X
Entity Type: Organization

Specialization: Multi-Specialty

CLIA Number: 26D2118598

Address:
1241 W STADIUM BLVD
FIRST FLOOR, SUITE 1100
JEFFERSON CITY, MO
ZIP 65109
Phone: (573) 556-5747
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JEFFERSON CITY MEDICAL GROUP, P.C. is a multi-specialty clinic center in Jefferson City, MO. JEFFERSON CITY MEDICAL GROUP, P.C. NPI is 1336189398. The provider is registered as an organization entity type.

The provider's business location address is:

1241 W STADIUM BLVD
FIRST FLOOR, SUITE 1100
JEFFERSON CITY, MO
ZIP 65109
Phone: (573) 556-5747
Fax: (573) 636-9756

The provider's authorized official is Jeffrey Patrick .
The authorized official title is President and has the following contact phone number (573) 635-5264.

The CLIA number assigned to this NPI record is 26D2118598 - ambulatory surgery center with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 6/7/2006 and was last updated on 6/8/2023.


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
1261QM1300XClinic/CenterMulti-SpecialtyYes

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
1CD6061OTHERMISSOURIMEDICARE RAILROAD
2CC7852OTHERMISSOURIMEDICARE RAILROAD
3CD6058OTHERMISSOURIMEDICARE RAILROAD
4CD6059OTHERMISSOURIMEDICARE RAILROAD
5CD6060OTHERMISSOURIMEDICARE RAILROAD

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: 5/5/2024
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