Organization
JEFFERSON CITY MEDICAL GROUP, P.C.
Active
Organization
JEFFERSON CITY MEDICAL GROUP, P.C.
Active
Other names
Womens Healthcare
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL CRAIGHEAD M.D. (COO)
(573) 556-7776
Entity
Organization
Contact information
Practice address
1241 W STADIUM BLVD, SUITE 1140, JEFFERSON CITY, MO 65109-6023
(573) 556-7717
(573) 556-1717
Mailing address
PO BOX 104240, JEFFERSON CITY, MO 65110-4240
(573) 556-7717
(573) 556-1717
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
507560001
—
MO
01
—
CC7852
MEDICARE RAILROAD
MO
Enumeration date
12/27/2006
Last updated
05/12/2010
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