Organization
JEFFERSON CITY MEDICAL GROUP, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY PATRICK MD (PRESIDENT)
(573) 635-5264
Entity
Organization
Contact information
Practice address
1241 W STADIUM BLVD, FIRST FLOOR, SUITE 1100, JEFFERSON CITY, MO 65109
(573) 556-5747
(573) 636-9756
Mailing address
PO BOX 104240, JEFFERSON CITY, MO 65110-4240
(573) 635-5264
(573) 636-9756
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CC7852
MEDICARE RAILROAD
MO
01
—
CD6058
MEDICARE RAILROAD
MO
01
—
CD6059
MEDICARE RAILROAD
MO
01
—
CD6060
MEDICARE RAILROAD
MO
01
—
CD6061
MEDICARE RAILROAD
MO
Enumeration date
06/07/2006
Last updated
06/08/2023
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