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General NPI Number Information
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NPI Number | 1982625802
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Entity Type | Organization
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Legal Business Name | FERGUSON MEDICAL GROUP RURAL HEALTH CENTER INC
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Dates
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Enumeration Date | 07/23/2006
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Last Update Date | 06/15/2017
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Provider Practice Location Address
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Address Line | 320 N LINCOLN ST
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City | EAST PRAIRIE
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State | MO
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Zip | 63845-1160
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Country | US
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Telephone | 573-649-3026
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Fax | 573-649-5600
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Provider Business Mailing Address
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Address Line | PO BOX 1068
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City | SIKESTON
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State | MO
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Zip | 63801-5044
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Country | US
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Telephone | 573-471-0330
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Fax | 573-481-5019
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Authorized Official
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Title or Position | CEO
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Name | MR. JAMES SHILL
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Credential |
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Telephone | 573-471-0330
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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 |
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License Number State | MO
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