Prime Care Family Medicine, Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

110888 Issued in MO

Legal business name

PRIME CARE FAMILY MEDICINE, INC

Practice address

117 E Hickory St
Neosho, MO 64850

Phone

(417) 451-4545

Fax

(417) 451-4546

NPI assigned

Nov 2, 2012

Organization subpart

No

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

Authorized official

Name

Craig L Pendergrass, DO

Title

Owner

Phone

(417) 451-4545

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1351814400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351814400000",
    "number": "1487908117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 220",
            "city": "NEOSHO",
            "state": "MO",
            "postal_code": "648500220",
            "telephone_number": "417-451-4545",
            "fax_number": "417-451-4546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117 E HICKORY ST",
            "city": "NEOSHO",
            "state": "MO",
            "postal_code": "64850",
            "telephone_number": "417-451-4545",
            "fax_number": "417-451-4546"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME CARE FAMILY MEDICINE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-02",
        "last_updated": "2012-11-02",
        "status": "A",
        "authorized_official_last_name": "PENDERGRASS",
        "authorized_official_first_name": "CRAIG",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "417-451-4545",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "110888",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joshua Platner, D.D.S.
• Kit Adam Plummer, PTA, LMT
• Journey Polacek, COTA
• Kristin Popa, P.T.
• Edward M Porter, D.O.
• Lucas Bryan Pryor
• Psychological Associates of Southwest Missouri, LLC
• Cheryl Ellen Rabe, M.S.,L.C.S.W.
• Patricia Ann Ramsey, MA CCC SLP
• Richard Rauk, CRNA

• Family Medicine Physician in Neosho, MO
• Providers in Neosho, 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 Nov 2, 2012; 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.