# JEFFERSON CITY MEDICAL GROUP, PC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** JCMG Path Lab
- **Organization subpart:** No

## Provider details

- **NPI number:** 1235723701
- **Authorized official:** PHYLLIS BLAKE (DIRECTOR OF REVENUE CYCLE)
- **Authorized official phone:** (573) 556-7721

## Contact information

- **Practice address:** 1241 W STADIUM BLVD, JEFFERSON CITY, MO 65109-6023
- **Practice address phone:** (573) 635-5264
- **Mailing address:** PO BOX 104240, JEFFERSON CITY, MO 65110-4240
- **Mailing address phone:** (573) 635-5264

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207ZP0102X | Anatomic Pathology & Clinical Pathology Physician | — | NULL | Yes |
| 207ZP0102X | Anatomic Pathology & Clinical Pathology Physician | — | — | Yes |

## Other

- **Enumeration date:** 02/25/2021
- **Last updated:** 02/25/2021