Organization
MOUNTAIN GROVE MEDICAL AND LASER CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DOYLE B HILL DO (PRESIDENT)
(417) 926-6643
Entity
Organization
Contact information
Practice address
601 N BUSCH AVE, MOUNTAIN GROVE, MO 65711
(417) 926-6643
(417) 926-6317
Mailing address
601 N BUSCH AVE, MOUNTAIN GROVE, MO 65711-1415
(417) 926-6643
(417) 926-6317
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
R7130
MO
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
243394905
—
MO
01
—
793840
RIVERBEND
MO
Enumeration date
01/25/2006
Last updated
05/14/2018
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