| Jefferson Medical Group | |
|
1502 N Jefferson St Carrollton MO 64633-1948 | |
| (660) 542-9998 | |
| (660) 542-9880 |
| Full Name | Jefferson Medical Group |
|---|---|
| Speciality | Family Medicine |
| Location | 1502 N Jefferson St, Carrollton, Missouri |
| Authorized Official Name and Position | Amy Danielle Ireland (CFO) |
| Authorized Official Contact | 6603296005 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jefferson Medical Group 1502 N Jefferson St Carrollton MO 64633-1948 Ph: (660) 542-9998 | Jefferson Medical Group 1502 N Jefferson St Carrollton MO 64633-1948 Ph: (660) 542-9998 |
| NPI Number | 1215030713 |
|---|---|
| Provider Enumeration Date | 09/07/2006 |
| Last Update Date | 10/29/2021 |
| Medicare PECOS PAC ID | 6800894379 |
|---|---|
| Medicare Enrollment ID | O20061116000198 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215030713 | NPI | - | NPPES |
| 50899330 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Secondary |
| Provider Name | Tara L Swan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982773586 PECOS PAC ID: 1153419304 Enrollment ID: I20071121000458 |
| Provider Name | Richard L Smith |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1861448664 PECOS PAC ID: 9931019189 Enrollment ID: I20080522000368 |
| Provider Name | Timothy N Reid |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1811090780 PECOS PAC ID: 0547314742 Enrollment ID: I20090824000191 |
| Provider Name | Pamela L Ralls |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1023252541 PECOS PAC ID: 6204025380 Enrollment ID: I20110105000151 |
| Provider Name | Gregory William Hubbard |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1932105673 PECOS PAC ID: 8224062856 Enrollment ID: I20110803000832 |
| Provider Name | Tanya W Land |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841625233 PECOS PAC ID: 8123255023 Enrollment ID: I20131223000672 |
| Provider Name | Andrew Horine |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1720342629 PECOS PAC ID: 0345475455 Enrollment ID: I20150522002408 |
| Provider Name | Jonna H Rechterman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700253812 PECOS PAC ID: 4789993247 Enrollment ID: I20151023000103 |
| Provider Name | Trent A Link |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154779866 PECOS PAC ID: 6305138793 Enrollment ID: I20160705001588 |
| Provider Name | Amy North |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1699189332 PECOS PAC ID: 8729209127 Enrollment ID: I20170824001335 |
| Provider Name | Heidi L Leimkuehler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750043725 PECOS PAC ID: 2466844782 Enrollment ID: I20220119001059 |
| Provider Name | Stefanie Leann Kissick |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1811766173 PECOS PAC ID: 5395197099 Enrollment ID: I20240118001362 |
Live Well Community Health Center Carrollton Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 300 E 9th St, Carrollton, MO 64633 Phone: 877-344-3572 Fax: 866-228-4492 | |
Hcc Network Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 718 Harvest Hills Dr, Carrollton, MO 64633 Phone: 877-344-3572 Fax: 866-228-4492 | |
Carroll County Medical Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1502 N Jefferson St, St Suite A B, Carrollton, MO 64633 Phone: 660-542-3865 Fax: 660-542-0336 | |
Jefferson Medical Group Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1502 N Jefferson St, Carrollton, MO 64633 Phone: 660-542-9998 Fax: 660-542-9880 | |
Hcc Of Carroll County Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1502 N Jefferson St, Carrollton, MO 64633 Phone: 660-542-1695 | |
Reid Medical Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1401 N Jefferson St, Carrollton, MO 64633 Phone: 660-542-3900 Fax: 660-542-3902 |