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Contact Information

JEFFERSON CITY MEDICAL GROUP, P.C.
1241 W STADIUM BLVD
SUITE L400B
JEFFERSON CITY, MO65109-6023
 Phone: 573-556-5747
 Fax: 573-636-9756
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Podiatrist

213E00000X 48 Podiatry
 

Durable Medical Equipment & Medical Supplies

332B00000X 54 Other Medical Supply Company
Indicates primary specialty

NPI Profile & details for JEFFERSON CITY MEDICAL GROUP PC · (Female)

NPI # 1871549345
Status Active
Credentials
Entity Individual
Enumeration date 05/26/2006
Last updated 10/03/2024 - More than a year ago
Sole proprietor 1 Not specified
Identifiers
  • MO Medicaid 506292002
  • MO Other 0428190006 DMERC/NORIDIAN
  • MO Other CC7852 MEDICARE RAILROAD
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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