| Physician Groups Lc | |
|
1103 W Liberty Farmington MO 63640-1921 | |
| (573) 756-7651 | |
| (573) 756-6807 |
| Full Name | Physician Groups Lc |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 1103 W Liberty, Farmington, Missouri |
| Authorized Official Name and Position | Karen Canter-koester (VP OPERATIONS AND STRATEGY) |
| Authorized Official Contact | 3149967610 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Physician Groups Lc 670 Mason Ridge Center Dr Ste 300 Saint Louis MO 63141-8573 Ph: (314) 996-7644 | Physician Groups Lc 1103 W Liberty Farmington MO 63640-1921 Ph: (573) 756-7651 |
| NPI Number | 1427114990 |
|---|---|
| Provider Enumeration Date | 12/29/2006 |
| Last Update Date | 08/11/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427114990 | NPI | - | NPPES |
| 500590104 | Medicaid | MO | |
| 596052704 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Secondary |
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
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