Organization
SB40 TCM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GARY WAYNE PHEGLEY (DIRECTOR)
(573) 546-3981
Entity
Organization
Contact information
Practice address
HC 1 BOX 2, MIDDLE BROOK, MO 63656-9701
(573) 546-3981
Mailing address
PO BOX 278, IRONTON, MO 63650-0278
(573) 546-3981
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
MO
251B00000X
Case Management Agency
—
—
Other
Enumeration date
12/02/2008
Last updated
12/02/2008
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