Organization
JEFFERSON MEDICAL GROUP
Active
Other names
Jefferson Medical Group Norborne Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
AMY DANIELLE IRELAND (CFO)
(660) 329-6005
Entity
Organization
Contact information
Practice address
105 E 2ND ST, NORBORNE, MO 64668-1301
(660) 593-3623
(660) 593-3628
Mailing address
1502 N JEFFERSON ST, CARROLLTON, MO 64633-1948
(660) 542-9998
(660) 542-9880
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
596573204
—
MO
Enumeration date
04/12/2011
Last updated
10/29/2021
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