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General NPI Number Information
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NPI Number | 1124237227
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Entity Type | Organization
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Legal Business Name | PCRMC MEDICAL GROUP, INC
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 08/13/2025
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Provider Practice Location Address
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Address Line | 1050 W 10TH ST
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City | ROLLA
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State | MO
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Zip | 65401-2905
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Country | US
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Telephone | 573-364-9000
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Fax | 573-458-3952
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Provider Business Mailing Address
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Address Line | PO BOX 579
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City | ROLLA
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State | MO
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Zip | 65402
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Country | US
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Telephone | 573-426-2182
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Fax | 573-426-5341
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Authorized Official
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Title or Position | VP, CHIEF FINANCIAL OFFICER
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Name | JANA M COOK
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Credential |
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Telephone | 573-458-7916
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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