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Organization

JCMG ANCILLARY SERVICES, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
CASSIE CALL (CREDENTIALING)
(573) 556-1783
Entity
Organization

Contact information

Practice address
1241 W STADIUM BLVD, JEFFERSON CITY, MO 65109-6023
(573) 635-5264
(573) 636-9756
Mailing address
1241 W STADIUM BLVD, JEFFERSON CITY, MO 65109-6023
(573) 635-5264
(573) 636-9756

Taxonomy

Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
0980220
MO
291U00000X
Clinical Medical Laboratory
26D0446044
MO
333600000X
Pharmacy
006386
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2631629
NABP
MO
01
470000400
RAILROAD MEDICARE
MO
05
718482300
MO
Enumeration date
01/27/2006
Last updated
10/30/2023
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