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NPI Code Detail

MEDICARE: JOSEPH E. PEHLMAN

MEDICARE: JOSEPH E. PEHLMAN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QR1300XRural Health Clinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1245212133
Entity Type Code : Organization
Provider Name (Legal Business Name) : JOSEPH E. PEHLMAN
Provider Business Mailing Address
First Line : PO BOX 526
Second Line : 1207 NORTH DOUGLASS STREET
City : MALDEN
State : MO
Zip : 63863-0526
Country : US
Telephone Number : 573-276-3884
Fax Number : 573-276-3885
Provider Business Practice Location Address
First Line : 1207 N DOUGLASS ST
Second Line :
City : MALDEN
State : MO
Zip : 63863-1351
Country : US
Telephone Number : 573-276-3884
Fax Number : 573-276-3885
Authorized Official
Title or Position : CEO
Name : JOSEPH E PEHLMAN
Credential : MD
Telephone Number : 573-276-3884
Provider Enumeration Date : 11/16/2005
Last Update Date : 10/23/2014

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