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Organization

PCRMC MEDICAL GROUP, INC

Active
Parent organization
PCRMC MEDICAL GROUP, INC
Other names
Phelps Health Medical Group Vienna
Organization subpart
Yes

Provider details

NPI number
Legal business name
PCRMC MEDICAL GROUP, INC
Authorized official
JANA M COOK (VP, CHIEF FINANCIAL OFFICER)
(573) 458-7916
Entity
Organization

Contact information

Practice address
606 HIGHWAY 63 S, VIENNA, MO 65582-8101
(573) 422-3636
(573) 422-3434
Mailing address
PO BOX 579, ROLLA, MO 65402
(573) 426-2182
(573) 426-5341

Taxonomy

Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
2007024375
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
594328304
MO
Enumeration date
09/14/2010
Last updated
01/17/2019
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