Healthcare Provider Details

I. General information

NPI: 1245212133
Provider Name (Legal Business Name): JOSEPH E. PEHLMAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 10/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1207 N DOUGLASS ST
MALDEN MO
63863-1351
US

IV. Provider business mailing address

PO BOX 526 1207 NORTH DOUGLASS STREET
MALDEN MO
63863-0526
US

V. Phone/Fax

Practice location:
  • Phone: 573-276-3884
  • Fax: 573-276-3885
Mailing address:
  • Phone: 573-276-3884
  • Fax: 573-276-3885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH E PEHLMAN
Title or Position: CEO
Credential: MD
Phone: 573-276-3884