PCRMC MEDICAL GROUP, INC (NPI# 1114235041) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114235041 |
| Entity Type | Organization |
| Organization Name | PCRMC MEDICAL GROUP, INC |
| Other Organization Name | PHELPS HEALTH MEDICAL GROUP VIENNA |
| Practice Address |
606 Highway 63 S Vienna MO 65582-8101 |
| Mailing Address |
Po Box 579 Rolla MO 65402 |
| Practice Telephone | 5734223636 |
| Practice Fax Number | 5734223434 |
| Mailing Telephone | 5734262182 |
| Mailing Fax Number | 5734265341 |
| Enumeration Date | 2010-09-14 |
| Last Update Date | 2019-01-17 |
| Authorized Official Name | JANA M COOK (VP, CHIEF FINANCIAL OFFICER) |
| Authorized Official Telephone | 5734587916 |
| Is Organization Subpart | Y |
| Parent Organization Name | PCRMC MEDICAL GROUP, INC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR1300X |
Clinic/Center Specialization: Rural Health |
2007024375 | MO | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | 594328304 | 05 |
| Other Name | Type Code |
|---|---|
| Phelps Health Medical Group Vienna | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457799520 | Pcrmc Medical Group, Inc | Clinic/Center | 1000 N Jefferson Street, St. James, MO 65559-1078 | 2013-06-11 |
| 1366066037 | Pcrmc Medical Group, Inc | Clinic/Center | 1050 W 10th St, Rolla, MO 65401-2905 | 2020-05-29 |
| 1194077701 | Pcrmc Medical Group, Inc | Clinic/Center | 1415 W Scenic Rivers Blvd, Salem, MO 65560-2840 | 2012-10-05 |
| 1124237227 | Pcrmc Medical Group, Inc | Internal Medicine | 1050 W 10th St, Rolla, MO 65401-2905 | 2007-05-22 |
| Street Address |
606 HIGHWAY 63 S |
| City | VIENNA |
| State | MO |
| Zip Code | 65582-8101 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538158274 | Medley Pharmacy Inc | Durable Medical Equipment & Medical Supplies | 606 Highway 63 S, Vienna, MO 65582-8101 | 2005-10-16 |
| 1093346181 | Jennifer Renae Berhorst | Pharmacist | 606 Highway 63 S, Vienna, MO 65582-8101 | 2020-01-28 |
| 1356819890 | Medley Pharmacy Inc | Pharmacy | 606 Highway 63 S, Vienna, MO 65582-8101 | 2018-11-02 |
| 1831141837 | Vienna Health Care | Family Medicine | 606 Highway 63 S, Vienna, MO 65582-8101 | 2006-05-17 |
| 1316928682 | Bryan Anthony Davis | Physician Assistant | 606 Highway 63 S, Vienna, MO 65582-8101 | 2005-11-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477867976 | Medley Pharmacy Inc. | Durable Medical Equipment & Medical Supplies | 606 E. Highway 63, Vienna, MO 65582 | 2010-07-27 |
| 1982856399 | Maries R-1 School District | Local Education Agency (LEA) | 161 5th Street, Vienna, MO 65582 | 2008-10-16 |
| 1669644746 | Quick Development Inc | Clinic/Center | 112 Parkway, Vienna, MO 65582 | 2008-03-28 |
| 1134127897 | Maries Osage Ambulance District | Ambulance | 164 Ballpark Road, Vienna, MO 65582 | 2005-07-07 |
| 1265055438 | Cynthia Louise Harris | Speech-Language Pathologist | 300 4th Street, Vienna, MO 65582 | 2020-05-22 |
| 1821304940 | Rachel Martin | Pharmacist | 606 Highway 63, Vienna, MO 65582-0606 | 2010-08-26 |
| 1417244146 | Joseph William Barnhart | Dentist | 1406 Hwy S, Vienna, MO 65582-0999 | 2011-07-01 |
| 1548473549 | John Francis Barnhart | Dentist | 1406 Hwy 63 S, Vienna, MO 65582-0999 | 2007-05-07 |
| 1548557325 | Joseph W Barnhart, Dds | Dentist | 1406 Hwy 63 S, Vienna, MO 65582-0999 | 2011-06-30 |
| 1043413073 | John F Barnhart, Dds, PC | Dentist | 1406 Hwy 63 S, Vienna, MO 65582-0999 | 2007-06-07 |
| Find all providers in zip 65582 | ||||
| Taxonomy Code | 261QR1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rural Health |
| Definition to come... |
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| 1639736457 | Southeast Health Center of Stoddard County LLC | Clinic/Center | 800 Us Highway 61, New Madrid, MO 63869-1106 | 2019-05-28 |
| 1134633456 | Pike County Memorial Hospital | Clinic/Center | 1420 S Business 61 Unit Fde, Bowling Green, MO 63334-5230 | 2017-11-22 |
| 1720505894 | Perry County Health System | Clinic/Center | 210 Hospital Ln Ste 202, Perryville, MO 63775-4200 | 2017-08-29 |
| 1427572007 | Missouri Delta Medical Center | Clinic/Center | 209 W Yoakum Ave, Chaffee, MO 63740-1138 | 2017-07-26 |
| 1790213676 | Jackson Primary Care LLC | Clinic/Center | 2685 E Main St Ste A, Jackson, MO 63755-2474 | 2017-05-23 |
| 1972050581 | Sgoh Acquisition, Inc. | Clinic/Center | 912b State Highway 59, Goodman, MO 64843-8252 | 2016-09-01 |
| 1144605312 | Nevada City Hospital | Clinic/Center | 627 S Ash St Ste B, Nevada, MO 64772 | 2015-07-29 |
| 1669856829 | Ssm Regional Health Services | Clinic/Center | 2511 W Edgewood Dr Ste F, Jefferson City, MO 65109-5869 | 2015-07-16 |
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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.