Healthcare Provider Details

I. General information

NPI: 1942335203
Provider Name (Legal Business Name): SGOH ACQUISITION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 08/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 SOUTH MAIN
ROGERSVILLE MO
65742
US

IV. Provider business mailing address

101 SOUTH MAIN
ROGERSVILLE MO
65742
US

V. Phone/Fax

Practice location:
  • Phone: 417-753-9404
  • Fax: 417-753-9137
Mailing address:
  • Phone: 417-753-9404
  • Fax: 417-753-9137

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 ADMINISTRATOR
Credential:
Phone: 417-837-4000