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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