Organization
FERGUSON MEDICAL GROUP RURAL HEALTH CENTER INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES SHILL (CEO)
(573) 471-0330
Entity
Organization
Contact information
Practice address
112 W COMMERCIAL ST, CHARLESTON, MO 63834-1601
(573) 683-4010
(573) 683-2167
Mailing address
PO BOX 1068, SIKESTON, MO 63801-1068
(573) 471-0330
(573) 481-5019
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
208000000X
Pediatrics Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1922332766
—
MO
Enumeration date
09/28/2009
Last updated
07/21/2022
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