Organization
JACKSON PRIMARY CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DEANNA M SIEMER MD (OWNER)
(573) 204-1400
Entity
Organization
Contact information
Practice address
2685 E MAIN ST SUITE A, STE A, JACKSON, MO 63755
(573) 204-1400
(573) 204-1480
Mailing address
2685 E MAIN ST SUITE A, STE A, JACKSON, MO 63755
(573) 204-1400
(573) 204-1480
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
261QR1300X
Rural Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
132588
BCBS
MO
05
—
509303004
—
MO
Enumeration date
09/08/2005
Last updated
10/26/2010
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