Healthcare Provider Details

I. General information

NPI: 1982254371
Provider Name (Legal Business Name): SGOH ACQUISITION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2019
Last Update Date: 03/21/2024
Certification Date: 03/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 ROCKETDYNE RD
NEOSHO MO
64850-3106
US

IV. Provider business mailing address

117 E HICKORY ST
NEOSHO MO
64850-1806
US

V. Phone/Fax

Practice location:
  • Phone: 417-451-7425
  • Fax: 417-451-7455
Mailing address:
  • Phone: 417-451-4545
  • Fax: 417-451-2341

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: 417-837-4004