Active NPI
Pcrmc Medical Group Inc
- Podiatrist
- Rolla, MO
National Provider Identifier
1093012890
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Podiatrist
- License
- 2009011768
- Legal business name
- PCRMC MEDICAL GROUP INC
- Practice address
- 1050 W 10TH St
Ste 420
Rolla, MO 65401-2905 - Phone
- (573) 458-3425
- Fax
- (573) 426-2282
- NPI assigned
- Feb 15, 2011
- Last updated
- Feb 15, 2011
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Hal Wagher
- Title
- Corporate Compliance Officer
- Phone
- (573) 458-7615
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | MODOR4D88 | MO | |
| Podiatrist | 213E00000X | 2009011768 | MO | Primary |
Addresses
Primary practice location
1050 W 10TH St
Ste 420
Rolla, MO 65401-2905
Mailing address
PO Box 579
Rolla, MO 65402-0579
Phone (573) 458-3425
National Provider Directory
National Provider Directory- Tax ID family
- Pcrmc Medical Group Inc
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
dba Phelps Health Medical Group Vienna
- Rural Health Clinic/Center
- Vienna, MO
- NPI 1114235041
Locations
1050 W 10th St
Ste 420
Rolla, MO 65401
Phone (573) 458-3425
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1297728000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1297728000000",
"number": "1093012890",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 579",
"city": "ROLLA",
"state": "MO",
"postal_code": "654020579",
"telephone_number": "573-458-3425",
"fax_number": "573-426-2282"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1050 W 10TH ST",
"address_2": "STE 420",
"city": "ROLLA",
"state": "MO",
"postal_code": "654012905",
"telephone_number": "573-458-3425",
"fax_number": "573-426-2282"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PCRMC MEDICAL GROUP INC",
"organizational_subpart": "NO",
"enumeration_date": "2011-02-15",
"last_updated": "2011-02-15",
"status": "A",
"authorized_official_last_name": "WAGHER",
"authorized_official_first_name": "HAL",
"authorized_official_title_or_position": "CORPORATE COMPLIANCE OFFICER",
"authorized_official_telephone_number": "573-458-7615"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "MO",
"license": "MODOR4D88",
"primary": false
},
{
"code": "213E00000X",
"taxonomy_group": "",
"desc": "Podiatrist",
"state": "MO",
"license": "2009011768",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rolla, MO
- Chloe Anastasia Parr, LP
- Julie Ann Parsons, LMSW
- Yogesh R Patel, MD
- Pathways Community Behavioral Healthcare, Inc
- Pcrmc - Bond Clinic Medical Group (Bond Clinic)
- Pcrmc Medical Group, Inc (Phelps Health Medical Group Rolla)
- Pcrmc Medical Group, Inc
- Pcrmc-Health Services, Inc. (Phelps Health Homecare)
- Pcrmc-Health Services, Inc. (Phelps Health Homecare)
- Pcrmc-Health Services, Inc. (Phelps Health Home Health & Hospice)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.