Organization
JEFFERSON CITY MEDICAL GROUP, P.C.
Active
Other names
JCMG Podiatry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY LEE PATRICK M.D. (PRESIDENT)
(573) 635-5264
Entity
Organization
Contact information
Practice address
1241 W STADIUM BLVD, SUITE L400B, JEFFERSON CITY, MO 65109-6023
(573) 556-5747
(573) 636-9756
Mailing address
PO BOX 104240, JEFFERSON CITY, MO 65110-4240
(573) 635-5264
(573) 636-9756
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0428190006
DMERC/NORIDIAN
MO
05
—
506292002
—
MO
01
—
CC7852
MEDICARE RAILROAD
MO
Enumeration date
05/26/2006
Last updated
10/03/2024
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