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Organization
JEFFERSON CITY MEDICAL GROUP, P.C.
Active
Organization
JEFFERSON CITY MEDICAL GROUP, P.C.
Active
Other names
JCMG Podiatry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY LEE PATRICK M.D. (PRESIDENT)
(573) 635-5264
Entity
Organization
Contact information
Practice address
1241 W STADIUM BLVD, SUITE L400B, JEFFERSON CITY, MO 65109-6023
(573) 556-5747
(573) 636-9756
Mailing address
PO BOX 104240, JEFFERSON CITY, MO 65110-4240
(573) 635-5264
(573) 636-9756
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0428190006
DMERC/NORIDIAN
MO
05
—
506292002
—
MO
01
—
CC7852
MEDICARE RAILROAD
MO
Enumeration date
05/26/2006
Last updated
10/03/2024
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