Healthcare Provider Details

I. General information

NPI: 1114924768
Provider Name (Legal Business Name): SGOH ACQUISITION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 E EVERGREEN ST
SPRINGFIELD MO
65803-4300
US

IV. Provider business mailing address

1540 E EVERGREEN ST
SPRINGFIELD MO
65803-4300
US

V. Phone/Fax

Practice location:
  • Phone: 417-823-2900
  • Fax: 417-886-2774
Mailing address:
  • Phone: 417-823-2900
  • Fax: 417-886-2774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number4546
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number454-8
License Number StateMO

VIII. Authorized Official

Name: MR. PAUL TAYLOR
Title or Position: CEO
Credential:
Phone: 417-837-2000