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Organization
JEFFERSON CITY MEDICAL GROUP, PC
Active
Organization
JEFFERSON CITY MEDICAL GROUP, PC
Active
Other names
JCMG Path Lab
Organization subpart
No
Provider details
NPI number
Authorized official
PHYLLIS BLAKE (DIRECTOR OF REVENUE CYCLE)
(573) 556-7721
Entity
Organization
Contact information
Practice address
1241 W STADIUM BLVD, JEFFERSON CITY, MO 65109-6023
(573) 635-5264
Mailing address
PO BOX 104240, JEFFERSON CITY, MO 65110-4240
(573) 635-5264
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
—
NULL
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
—
—
Other
Enumeration date
02/25/2021
Last updated
02/25/2021
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