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General NPI Number Information
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NPI Number | 1386191989
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Entity Type | Organization
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Legal Business Name | SGOH ACQUISITION, INC.
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Dates
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Enumeration Date | 09/01/2016
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Last Update Date | 09/01/2016
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Provider Practice Location Address
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Address Line | 412 US HIGHWAY 71 SUITE J & I
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City | PINEVILLE
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State | MO
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Zip | 64856-9310
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Country | US
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Telephone | 417-223-4290
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Fax |
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Provider Business Mailing Address
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Address Line | 412 US HIGHWAY 71 SUITE J & I
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City | PINEVILLE
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State | MO
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Zip | 64856-9310
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Country | US
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Telephone | 417-223-4290
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | PAUL TAYLOR
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Credential | JD
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Telephone | 417-837-4090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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