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Organization

PCRMC MEDICAL GROUP INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
HAL WAGHER (CORPORATE COMPLIANCE OFFICER)
(573) 458-7615
Entity
Organization

Contact information

Practice address
1050 W 10TH ST, STE 420, ROLLA, MO 65401-2905
(573) 458-3425
(573) 426-2282
Mailing address
PO BOX 579, ROLLA, MO 65402-0579
(573) 458-3425
(573) 426-2282

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
MODOR4D88
MO
213E00000X
Podiatrist
Primary
2009011768
MO

Other

Enumeration date
02/15/2011
Last updated
02/15/2011
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