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Organization
JACKSON MEDICAL CENTER PC
Active
Organization
JACKSON MEDICAL CENTER PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STACEY L CANTRELL (MANAGER)
(573) 335-1779
Entity
Organization
Contact information
Practice address
2387 W JACKSON BLVD, JACKSON, MO 63755-3024
(573) 243-9288
(573) 204-7074
Mailing address
2387 W JACKSON BLVD, JACKSON, MO 63755-3024
(573) 243-9288
(573) 204-7074
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
12/05/2007
Last updated
10/07/2020
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