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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, P.C.

NPI Number 1871549345
LBN Legal business name JEFFERSON CITY MEDICAL GROUP, P.C.
Authorized official JEFFREY PATRICK - (PRESIDENT)
Entity Organization
Organization subpart 1 No
Enumeration date 05/26/2006
Last updated 10/03/2024 - More than a year ago
Identifiers
MO Medicaid 506292002
MO Other 0428190006 DMERC/NORIDIAN
MO Other CC7852 MEDICARE RAILROAD
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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