Healthcare Provider Details

I. General information

NPI: 1124237227
Provider Name (Legal Business Name): PCRMC MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 W 10TH ST
ROLLA MO
65401-2905
US

IV. Provider business mailing address

PO BOX 579
ROLLA MO
65402
US

V. Phone/Fax

Practice location:
  • Phone: 573-364-9000
  • Fax: 573-458-3952
Mailing address:
  • Phone: 573-426-2182
  • Fax: 573-426-5341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JANA M COOK
Title or Position: VP, CHIEF FINANCIAL OFFICER
Credential:
Phone: 573-458-7916