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1616 Southridge Dr Suite 203 Jefferson City MO 65109-5677 | |
(573) 659-7300 | |
(573) 636-0555 |
Full Name | |
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Speciality | Clinic/center |
Location | 1616 Southridge Dr, Jefferson City, Missouri |
Authorized Official Name and Position | Tom Luebbering (VP OF FINANCE) |
Authorized Official Contact | 5736325100 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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1616 Southridge Dr Suite 203 Jefferson City MO 65109-5677 Ph: (573) 659-7300 | 1616 Southridge Dr Suite 203 Jefferson City MO 65109-5677 Ph: (573) 659-7300 |
NPI Number | 1588979900 |
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Provider Enumeration Date | 08/10/2010 |
Last Update Date | 08/21/2014 |
Identifier | Type | State | Issuer |
---|---|---|---|
1588979900 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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Family Medicine Of Jefferson City, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1616 Southridge Dr, Suite #203, Jefferson City, MO 65109 Phone: 573-659-7300 Fax: 573-636-0555 | |
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