Healthcare Provider Details

I. General information

NPI: 1982625802
Provider Name (Legal Business Name): FERGUSON MEDICAL GROUP RURAL HEALTH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 06/15/2017
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

PO BOX 1068
SIKESTON MO
63801-5044
US

V. Phone/Fax

Practice location:
  • Phone: 573-649-3026
  • Fax: 573-649-5600
Mailing address:
  • Phone: 573-471-0330
  • Fax: 573-481-5019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. JAMES SHILL
Title or Position: CEO
Credential:
Phone: 573-471-0330