# PRIME CARE FAMILY MEDICINE, INC

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

## Provider details

- **NPI number:** 1487908117
- **Authorized official:** CRAIG L PENDERGRASS DO (OWNER)
- **Authorized official phone:** (417) 451-4545

## Contact information

- **Practice address:** 117 E HICKORY ST, NEOSHO, MO 64850
- **Practice address phone:** (417) 451-4545
- **Practice address fax:** (417) 451-4546
- **Mailing address:** PO BOX 220, NEOSHO, MO 64850-0220
- **Mailing address phone:** (417) 451-4545
- **Mailing address fax:** (417) 451-4546

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 110888 | MO | Yes |

## Other

- **Enumeration date:** 11/02/2012
- **Last updated:** 11/02/2012