Healthcare Provider Details

I. General information

NPI: 1225338155
Provider Name (Legal Business Name): SGOH ACQUISITION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2010
Last Update Date: 07/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

543 W HUBBLE DR
MARSHFIELD MO
65706-1532
US

IV. Provider business mailing address

2828 N NATIONAL AVE
SPRINGFIELD MO
65803-4306
US

V. Phone/Fax

Practice location:
  • Phone: 417-859-4878
  • Fax:
Mailing address:
  • Phone: 417-837-4000
  • Fax:

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: PAUL G TAYLOR
Title or Position: CEO
Credential:
Phone: 417-837-4090