Organization
SGOH ACQUISITION INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PAUL TAYLOR (CEO)
(417) 837-2000
Entity
Organization
Contact information
Practice address
1540 E EVERGREEN ST, SPRINGFIELD, MO 65803-4300
(417) 823-2900
(417) 886-2774
Mailing address
1540 E EVERGREEN ST, SPRINGFIELD, MO 65803-4300
(417) 823-2900
(417) 886-2774
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
4546
MO
283Q00000X
Psychiatric Hospital
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
454-8
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010564409
—
MO
05
—
121295105
—
AR
05
—
540564408
—
MO
01
—
CR0762
RR MEDICARE
MO
Enumeration date
06/28/2005
Last updated
07/16/2024
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