Healthcare Provider Details

I. General information

NPI: 1245365337
Provider Name (Legal Business Name): FERGUSON MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 N LINCOLN ST
EAST PRAIRIE MO
63845-1160
US

IV. Provider business mailing address

320 N LINCOLN ST
EAST PRAIRIE MO
63845-1160
US

V. Phone/Fax

Practice location:
  • Phone: 573-649-3026
  • Fax:
Mailing address:
  • Phone: 573-649-3026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KELLEY J RUSHING
Title or Position: CEO
Credential:
Phone: 573-471-0330