Organization
PRIME CARE FAMILY MEDICINE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CRAIG L PENDERGRASS DO (OWNER)
(417) 451-4545
Entity
Organization
Contact information
Practice address
117 E HICKORY ST, NEOSHO, MO 64850
(417) 451-4545
(417) 451-4546
Mailing address
PO BOX 220, NEOSHO, MO 64850-0220
(417) 451-4545
(417) 451-4546
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
110888
MO
Other
Enumeration date
11/02/2012
Last updated
11/02/2012
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