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General NPI Number Information
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NPI Number | 1467518464
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Entity Type | Organization
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Legal Business Name | EASTERN MISSOURI GENERAL SERVICES INC
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Dates
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Enumeration Date | 12/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 322 NO STATE STREET
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City | DESLOGE
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State | MO
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Zip | 63601-3052
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Country | US
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Telephone | 573-431-4510
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Fax | 573-431-4790
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Provider Business Mailing Address
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Address Line | 322 NO STATE STREET
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City | DESLOGE
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State | MO
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Zip | 63601-3052
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Country | US
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Telephone | 573-431-4510
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Fax | 573-431-4790
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Authorized Official
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Title or Position | PRESIDENT PHYSICIAN
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Name | MR. RIOHARD MARTIN SECOR JR.
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Credential | DO
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Telephone | 573-431-4510
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 10179
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | R9A44
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License Number State | MO
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