| Internal Medicine | |
|
1241 W Stadium Blvd Second Floor, Suite 2200 Jefferson City MO 65109-6023 | |
| (573) 556-5747 | |
| (573) 636-9756 |
| Full Name | Internal Medicine |
|---|---|
| Speciality | Internal Medicine |
| Location | 1241 W Stadium Blvd, Jefferson City, Missouri |
| Authorized Official Name and Position | Jeffrey Lee Patrick (PRESIDENT) |
| Authorized Official Contact | 5736355264 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Internal Medicine Po Box 104240 Jefferson City MO 65110-4240 Ph: (573) 635-5264 | Internal Medicine 1241 W Stadium Blvd Second Floor, Suite 2200 Jefferson City MO 65109-6023 Ph: (573) 556-5747 |
| NPI Number | 1699715656 |
|---|---|
| Provider Enumeration Date | 06/07/2006 |
| Last Update Date | 05/09/2023 |
| Certification Date | 05/09/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699715656 | NPI | - | NPPES |
| CP9089 | Other | MEDICARE RAILROAD | |
| CC7852 | Other | MO | MEDICARE RAILROAD |
| CD6058 | Other | MO | MEDICARE RAILROAD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | () | Primary |
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