Family Medicine of Jefferson City, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

R9J28 Issued in MO

Legal business name

FAMILY MEDICINE OF JEFFERSON CITY, LLC

Practice address

1616 Southridge Dr
Suite #203
Jefferson City, MO 65109-5677

Phone

(573) 659-7300

Fax

(573) 636-0555

NPI assigned

Sep 21, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Daniel P Lavery, M.D.NPI 1083719975

Title

Owner/President

Phone

(573) 659-7300

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Daniel P Lavery, M.D.

  • Family Medicine Physician
  • Jefferson City, MO
  • NPI 1083719975
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1043319957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1616 SOUTHRIDGE DR",
            "address_2": "SUITE #203",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651095677",
            "telephone_number": "573-659-7300",
            "fax_number": "573-636-0555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1616 SOUTHRIDGE DR",
            "address_2": "SUITE #203",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651095677",
            "telephone_number": "573-659-7300",
            "fax_number": "573-636-0555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY MEDICINE OF JEFFERSON CITY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LAVERY",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "573-659-7300",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "R9J28",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Joseph M. Faries, CRNA
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• Loretta J. Feeler, D.O.

• Family Medicine Physician in Jefferson City, MO
• Providers in Jefferson City, MO by specialty
• Family Medicine Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.