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NPI Code Detail

MEDICARE: SGOH ACQUISITION, INC.

MEDICARE: SGOH ACQUISITION, INC.
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

General Provider Information

NPI Number : 1801343405
Entity Type Code : Organization
Provider Name (Legal Business Name) : SGOH ACQUISITION, INC.
Provider Business Mailing Address
First Line : 109 N BROADWAY ST
Second Line :
City : SOUTH WEST CITY
State : MO
Zip : 64863-9417
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 109 N BROADWAY ST
Second Line :
City : SOUTH WEST CITY
State : MO
Zip : 64863-9417
Country : US
Telephone Number : 417-762-3287
Fax Number :
Authorized Official
Title or Position : CEO
Name : PAUL TAYLOR
Credential : JD
Telephone Number : 417-837-4090
Provider Enumeration Date : 09/01/2016
Last Update Date : 09/15/2016

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