Jefferson City Medical Group-P C

Key facts

NPI

1235533498

Entity type

Organization (NPI type 2)

Primary specialty

Family Medicine Physician 207Q00000X

Legal business name

JEFFERSON CITY MEDICAL GROUP-P C

Practice address

2303 S Highway 65 Ste a
Marshall, MO 65340-3735

Phone

(660) 886-3364

Fax

(660) 886-6044

NPI assigned

Oct 17, 2014

Organization subpart

No

Authorized official

Name

Jeffrey Lee Patrick, MD

Title

President

Phone

(573) 635-5264

National Provider Directory

Locations

Specialties & licenses

Addresses

Other identifiers

Other names

• Missouri Valley Physicians A Division of JCMG Doing business as

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Dec 26, 2018.

{
    "created_epoch": "1413504000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1545782400000",
    "number": "1235533498",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 104240",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651104240",
            "telephone_number": "573-635-5264",
            "fax_number": "573-556-5757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2303 S HIGHWAY 65 STE A",
            "city": "MARSHALL",
            "state": "MO",
            "postal_code": "653403735",
            "telephone_number": "660-886-3364",
            "fax_number": "660-886-6044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON CITY MEDICAL GROUP-P C",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-17",
        "last_updated": "2018-12-26",
        "status": "A",
        "authorized_official_last_name": "PATRICK",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "573-635-5264",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1235533498",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Missouri Valley Physicians A Division of JCMG",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Marshall, MO

• Stacey Lynn Hostetter, RD
• Preston B Howerton, DO
• Dennis Leon Hunter, O.D.
• Isd Renal Inc
• Nicholas Jackson
• Jefferson City Medical Group, PC
• John Fitzgibbon Memorial Hospital
• John Fitzgibbon Memorial Hospital Inc
• John Fitzgibbon Memorial Hospital Inc
• John Fitzgibbon Memorial Hospital Inc

All providers in Marshall, MO · Family Medicine Physician in Missouri