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Organization
JEFFERSON MEDICAL GROUP
Active
Organization
JEFFERSON MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMY DANIELLE IRELAND (CFO)
(660) 329-6005
Entity
Organization
Contact information
Practice address
1502 N JEFFERSON ST, CARROLLTON, MO 64633-1948
(660) 542-9998
(660) 542-9880
Mailing address
1502 N JEFFERSON ST, CARROLLTON, MO 64633-1948
(660) 542-9998
(660) 542-9880
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
261QR1300X
Rural Health Clinic/Center
—
NULL
Other
Enumeration date
09/07/2006
Last updated
10/29/2021
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