| Jefferson Medical Group | |
|
807 E Broadway St Brunswick MO 65236-1468 | |
| (660) 542-1695 | |
| Not Available |
| Full Name | Jefferson Medical Group |
|---|---|
| Speciality | Family Medicine |
| Location | 807 E Broadway St, Brunswick, Missouri |
| Authorized Official Name and Position | Amy Danielle Ireland (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 6605421695 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jefferson Medical Group 1502 N Jefferson St Carrollton MO 64633-1948 Ph: (660) 542-1695 | Jefferson Medical Group 807 E Broadway St Brunswick MO 65236-1468 Ph: (660) 542-1695 |
| NPI Number | 1104432806 |
|---|---|
| Provider Enumeration Date | 09/17/2020 |
| Last Update Date | 10/29/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104432806 | NPI | - | NPPES |
| 508993300 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Grand River Medical Center Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 815 E. Broadway Street, Brunswick, MO 65236 Phone: 660-886-7431 Fax: 660-831-3328 |