# JEFFERSON MEDICAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104432806
- **Authorized official:** LESLEY DELANEY (CHIEF FINANCIAL OFFICER)
- **Authorized official phone:** (660) 542-1695

## Contact information

- **Practice address:** 807 E BROADWAY ST, BRUNSWICK, MO 65236-1468
- **Practice address phone:** (660) 542-1695
- **Mailing address:** 1502 N JEFFERSON ST, CARROLLTON, MO 64633-1948
- **Mailing address phone:** (660) 542-1695

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 261QR1300X | Rural Health Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 09/17/2020
- **Last updated:** 05/12/2025