PCRMC MEDICAL GROUP INC (NPI# 1093012890) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093012890 |
| Entity Type | Organization |
| Organization Name | PCRMC MEDICAL GROUP INC |
| Practice Address |
1050 W 10th St Ste 420 Rolla MO 65401-2905 |
| Mailing Address |
Po Box 579 Rolla MO 65402-0579 |
| Practice Telephone | 5734583425 |
| Practice Fax Number | 5734262282 |
| Mailing Telephone | 5734583425 |
| Mailing Fax Number | 5734262282 |
| Enumeration Date | 2011-02-15 |
| Last Update Date | 2011-02-15 |
| Authorized Official Name | HAL WAGHER (CORPORATE COMPLIANCE OFFICER) |
| Authorized Official Telephone | 5734587615 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 174400000X | Specialist | MODOR4D88 | MO | Other Service Providers |
| Y | 213E00000X | Podiatrist | 2009011768 | MO | Podiatric Medicine & Surgery Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447430574 | Pcrmc Medical Group Inc | Pediatrics | 1000 Gw Lane, Waynesville, MO 65583-5401 | 2007-11-06 |
| 1942491212 | Pcrmc Medical Group Inc | Otolaryngology | 1501 E 10th St, Suite B, Rolla, MO 65401-3696 | 2007-08-05 |
| Street Address |
1050 W 10TH ST STE 420 |
| City | ROLLA |
| State | MO |
| Zip Code | 65401-2905 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518962570 | Donald James Mcmullin | Internal Medicine | 1050 W 10th St, Rolla, MO 65401 | 2005-06-16 |
| 1366066037 | Pcrmc Medical Group, Inc | Clinic/Center | 1050 W 10th St, Rolla, MO 65401-2905 | 2020-05-29 |
| 1659857415 | Josie Leann Eoff | Nurse Practitioner | 1050 W 10th St, Rolla, MO 65401 | 2018-07-16 |
| 1659893758 | Joshua Thomas Turnbaugh | Nurse Practitioner | 1050 W 10th St, Rolla, MO 65401 | 2017-07-10 |
| 1700327897 | Emily Wiseman | Nurse Practitioner | 1050 W 10th St, Rolla, MO 65401 | 2017-03-09 |
| 1487046181 | Pamela N. Gray | Physician Assistant | 1050 W 10th St, Rolla, MO 65401-2905 | 2015-03-04 |
| 1174928857 | Arezo Hesaraki | Dentist | 1050 W 10th St, Ste 480, Rolla, MO 65401-2905 | 2014-10-23 |
| 1922416296 | Karen Ulrich | Advanced Practice Midwife | 1050 W 10th St, Rolla, MO 65401-2905 | 2014-07-30 |
| 1093142531 | Meredith Leigh Napierala | Nurse Practitioner | 1050 W 10th St, Rolla, MO 65401-2905 | 2013-09-30 |
| 1528409638 | Curtis Morrison | Internal Medicine | 1050 W 10th St, Rolla, MO 65401-2905 | 2013-07-17 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639645591 | Samantha Jo Mitchell | Pharmacist | 1375 E 10th St Suite B, Rolla, MO 65401 | 2018-10-18 |
| 1427567726 | Gerry Wade Funkhouser Jr. | Counselor | 103 W 10th St, Rolla, MO 65401 | 2017-09-29 |
| 1366967960 | Shana Hintz Wisniewski | Social Worker | 1000 W. 10th St., Rolla, MO 65401 | 2017-08-04 |
| 1174066559 | Tabitha Hundt | Counselor | 1011 Cypress Dr, Rolla, MO 65401 | 2016-12-02 |
| 1841742855 | Alpha Assisted Living LLC | Assisted Living Facility | 13450 Cr 7040, 803 E 12th St, Rolla, MO 65401 | 2016-10-26 |
| 1275916884 | Elizabeth Zersen | Occupational Therapist | 2053 Vienna Rd, Rolla, MO 65401 | 2015-06-30 |
| 1386047025 | Becky L Witham | Nurse Practitioner | 1060 W 10th Street, Rolla, MO 65401 | 2014-10-08 |
| 1114326121 | Summer Adey | Licensed Practical Nurse | 13750 State Route F, Rolla, MO 65401 | 2014-08-14 |
| 1518303296 | Leaetta Mildred Gardner | Nursing Facility/Intermediate Care Facility | 13450 County Road 7040, Rolla, MO 65401 | 2013-05-21 |
| 1316282064 | Susan Peitz Gruener | Occupational Therapy Assistant | 1800 White Column Road, Rolla, MO 65401 | 2012-12-06 |
| Find all providers in zip 65401 | ||||
| Taxonomy Code | 213E00000X |
| Grouping | Podiatric Medicine & Surgery Service Providers |
| Classification | Podiatrist |
| A podiatrist is a person qualified by a Doctor of Podiatric Medicine (D.P.M.) degree, licensed by the state, and practicing within the scope of that license. Podiatrists diagnose and treat foot diseases and deformities. They perform medical, surgical and other operative procedures, prescribe corrective devices and prescribe and administer drugs and physical therapy. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609888288 | Joshua C Garrison | Podiatrist | 1605 Martin Springs Dr, Rolla, MO 65401-2931 | 2006-08-12 |
| 1316960008 | Robert Pearson | Podiatrist | 600 Blues Lake Pkwy, Rolla, MO 65401-8022 | 2006-07-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902421696 | Kiera Margaret Benge-shea | Podiatrist | 12255 Depaul Drive, Ste 705, Bridgeton, MO 63055 | 2020-06-09 |
| 1972069359 | Dr Jeffrey Brooks PC | Podiatrist | 618 N New Ballas Rd Apt 409, Saint Louis, MO 63141-6767 | 2019-02-11 |
| 1619448453 | S Thomas Sehy D P M L L C | Podiatrist | 6651 Chippewa St Ste 316, Saint Louis, MO 63109-2532 | 2018-12-05 |
| 1902339104 | Jay J Moradia | Podiatrist | 621 S New Ballas Rd Ste 7005b, Saint Louis, MO 63141-8275 | 2017-04-05 |
| 1992185763 | Melanie Gonzalez | Podiatrist | 2406 E R.d. Mize Rd Ste. B, Independence, MO 64057-6405 | 2015-06-05 |
| 1255727525 | Mobile Podiatry of Kansas, LLC | Podiatrist | 1920 Salter Pl, Kirksville, MO 63501-5165 | 2015-04-13 |
| 1346645496 | Ronald Ethan Freilich | Podiatrist | 25107 Cherokee Ln, Jonesburg, MO 63351-2454 | 2014-10-31 |
| 1972922060 | Special Care Podiatry of Missouri, LLC | Podiatrist | 3714 Kidron St, Jackson, MO 63755-3345 | 2014-04-16 |
| 1003152273 | Foot Healers Holdings - St. Louis, LLC | Podiatrist | 8534 Eager Rd, Saint Louis, MO 63144-1435 | 2012-12-17 |
| 1073870234 | Richard Don Bushman | Podiatrist | 603 Claymont Estates Dr, Chesterfield, MO 63017-7061 | 2012-04-12 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.