Healthcare Provider Details

I. General information

NPI: 1568502631
Provider Name (Legal Business Name): SGOH ACQUISITION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 10/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 S HICKORY ST
MOUNT VERNON MO
65712-1407
US

IV. Provider business mailing address

108 S HICKORY ST
MOUNT VERNON MO
65712-1407
US

V. Phone/Fax

Practice location:
  • Phone: 417-466-4110
  • Fax: 417-466-4255
Mailing address:
  • Phone: 417-466-4110
  • Fax: 417-466-4255

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: ADMINISTRATOR CEO
Credential:
Phone: 417-837-4000