# JEFFERSON MEDICAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Jefferson Medical Group Hale Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1760772743
- **Authorized official:** AMY DANIELLE IRELAND (CFO)
- **Authorized official phone:** (660) 329-6005

## Contact information

- **Practice address:** 221 ELM ST, HALE, MO 64643-7113
- **Practice address phone:** (660) 565-2602
- **Practice address fax:** (660) 565-2604
- **Mailing address:** 1502 N JEFFERSON ST, CARROLLTON, MO 64633-1948
- **Mailing address phone:** (660) 542-9998
- **Mailing address fax:** (660) 542-9880

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR1300X | Rural Health Clinic/Center | — | MO | Yes |

## Other

- **Enumeration date:** 04/12/2011
- **Last updated:** 10/29/2021