# PCRMC MEDICAL GROUP, INC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** PCRMC MEDICAL GROUP, INC
- **Other names:** Phelps Health Medical Group Vienna
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1114235041
- **Legal business name:** PCRMC MEDICAL GROUP, INC
- **Authorized official:** JANA M COOK (VP, CHIEF FINANCIAL OFFICER)
- **Authorized official phone:** (573) 458-7916

## Contact information

- **Practice address:** 606 HIGHWAY 63 S, VIENNA, MO 65582-8101
- **Practice address phone:** (573) 422-3636
- **Practice address fax:** (573) 422-3434
- **Mailing address:** PO BOX 579, ROLLA, MO 65402
- **Mailing address phone:** (573) 426-2182
- **Mailing address fax:** (573) 426-5341

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR1300X | Rural Health Clinic/Center | 2007024375 | MO | Yes |

## Other

- **Enumeration date:** 09/14/2010
- **Last updated:** 01/17/2019