Organization
JEFFERSON CITY MEDICAL GROUP, PC
Active
Other names
JCMG Path Lab
Organization subpart
No
Provider details
NPI number
Authorized official
PHYLLIS BLAKE (DIRECTOR OF REVENUE CYCLE)
(573) 556-7721
Entity
Organization
Contact information
Practice address
1241 W STADIUM BLVD, JEFFERSON CITY, MO 65109-6023
(573) 635-5264
Mailing address
PO BOX 104240, JEFFERSON CITY, MO 65110-4240
(573) 635-5264
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
—
—
Other
Enumeration date
02/25/2021
Last updated
02/25/2021
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