JEFFERSON MEDICAL GROUP (NPI# 1104432806) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104432806 |
| Entity Type | Organization |
| Organization Name | JEFFERSON MEDICAL GROUP |
| Practice Address |
807 E Broadway St Brunswick MO 65236-1468 |
| Mailing Address |
1502 N Jefferson St Carrollton MO 64633-1948 |
| Practice Telephone | 6605421695 |
| Mailing Telephone | 6605421695 |
| Enumeration Date | 2020-09-17 |
| Last Update Date | 2020-09-17 |
| Authorized Official Name | AMY DANIELLE IRELAND (CHIEF FINANCIAL OFFICER) |
| Authorized Official Telephone | 6605421695 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982034773 | Jefferson Medical Group | Clinic/Center | 608 Missouri St, Waverly, MO 64096-8241 | 2013-11-15 |
| 1760772743 | Jefferson Medical Group | Clinic/Center | 221 Elm St, Hale, MO 64643-7113 | 2011-04-12 |
| 1467742452 | Jefferson Medical Group | Clinic/Center | 105 E 2nd St, Norborne, MO 64668-1301 | 2011-04-12 |
| 1619276367 | Jefferson Medical Group | Clinic/Center | 1502 N Jefferson St, Carrollton, MO 64633-1948 | 2011-03-21 |
| 1215030713 | Jefferson Medical Group | Clinic/Center | 1502 N Jefferson St, Carrollton, MO 64633-1948 | 2006-09-07 |
| Street Address |
807 E BROADWAY ST |
| City | BRUNSWICK |
| State | MO |
| Zip Code | 65236-1468 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518075316 | Jessica L Elliott | Speech-Language Pathologist | 107 E Harrison St, Brunswick, MO 65236 | 2006-08-29 |
| 1265422331 | Lightning Creek Investment Group,inc | Skilled Nursing Facility | 721 W Harrison St, Brunswick, MO 65236 | 2005-10-28 |
| 1093295354 | Paige Mchugh | Physical Therapy Assistant | 406 Keyte St, Brunswick, MO 65236-1036 | 2018-08-16 |
| 1700422482 | Ashley Simpson | Occupational Therapy Assistant | 721 W Harrison St, Brunswick, MO 65236-1096 | 2019-11-18 |
| 1518503200 | Margaret J Larson | Speech-Language Pathologist | 721 W Harrison St, Brunswick, MO 65236-1096 | 2019-11-18 |
| 1922540848 | Jukeco Enterprises LLC | Skilled Nursing Facility | 721 W Harrison St, Brunswick, MO 65236-1096 | 2016-11-09 |
| 1205013224 | Danielle Elizabeth Hamilton | Physical Therapy Assistant | 721 W Harrison St, Brunswick, MO 65236-1096 | 2008-01-22 |
| 1417011313 | Joanie M Defibaugh | Social Worker | 107 E Harrison St, Brunswick, MO 65236-1267 | 2006-12-22 |
| 1366581951 | Brunswick R-ii Schools | Physical Therapist | 1008 County Rd, Brunswick, MO 65236-1445 | 2007-02-06 |
| 1619200565 | Nancy J Lock | Physical Therapist | 1008 County Rd, Brunswick, MO 65236-1445 | 2009-09-10 |
| Find all providers in zip 65236 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124465588 | Bianca Rae Pope | Family Medicine | 3010 Altama Ave, Brunswick, GA 31520-4607 | 2013-05-25 |
| 1811269632 | Solar Family Practice | Family Medicine | 122 Scranton Connector, Suite 112, Brunswick, GA 31525 | 2012-02-09 |
| 1952531493 | Richard P Mcewan | Family Medicine | 160 Juniper Ct Ste 101, Brunswick, GA 31520-1952 | 2009-07-17 |
| 1972775815 | Best Care Solutions, Corp | Family Medicine | 1825 Glynn Ave Ste 50, Brunswick, GA 31520-6107 | 2008-04-01 |
| 1417152737 | Golden Isles Family Medicine | Family Medicine | 114 Northpark Drive, Brunswick, GA 31520 | 2007-06-18 |
| 1700091030 | Jacqueline Marie Caldwell | Family Medicine | 7 Farley Rd, Brunswick, ME 04011 | 2007-05-11 |
| 1821200502 | Larry Keith Laclair | Family Medicine | 25 Macmillan Drive, Brunswick, ME 04011-3222 | 2007-05-04 |
| 1912056474 | Family Practitioners of Glynn, PC | Family Medicine | 390 Eh Ct, Brunswick, GA 31520-2198 | 2007-01-10 |
| 1588720601 | Patsy Mitchell | Family Medicine | 118 Northpark Dr, Brunswick, GA 31520-2111 | 2007-01-01 |
| 1740358555 | John Henley Kanwit | Family Medicine | 4 Bunganuc Landing Rd, Brunswick, ME 04011-7325 | 2006-12-01 |
| Find all providers in BRUNSWICK | ||||
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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.