PCRMC MEDICAL GROUP, INC (NPI# 1366066037) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366066037 |
| Entity Type | Organization |
| Organization Name | PCRMC MEDICAL GROUP, INC |
| Practice Address |
1050 W 10th St Rolla MO 65401-2905 |
| Practice Telephone | 5733649000 |
| Mailing Telephone | 5734262182 |
| Mailing Fax Number | 5734265341 |
| Enumeration Date | 2020-05-29 |
| Last Update Date | 2020-05-29 |
| Authorized Official Name | GRACE JOANN MALNAR (CREDENTIALING) |
| Authorized Official Telephone | 5734588616 |
| Authorized Official Credential | BA |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR1300X |
Clinic/Center Specialization: Rural Health |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Phelps Health Medical Group | 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 |
| 1194077701 | Pcrmc Medical Group, Inc | Clinic/Center | 1415 W Scenic Rivers Blvd, Salem, MO 65560-2840 | 2012-10-05 |
| 1114235041 | Pcrmc Medical Group, Inc | Clinic/Center | 606 Highway 63 S, Vienna, MO 65582-8101 | 2010-09-14 |
| 1124237227 | Pcrmc Medical Group, Inc | Internal Medicine | 1050 W 10th St, Rolla, MO 65401-2905 | 2007-05-22 |
| Street Address |
1050 W 10TH ST |
| 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 |
| 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 |
| 1194161174 | Dmitry Familtsev | Internal Medicine | 1050 W 10th St, Rolla, MO 65401-2905 | 2013-05-16 |
| 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 | 261QR1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rural Health |
| Definition to come... |
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|---|---|---|---|---|
| 1326416025 | Morton County Hospital | Clinic/Center | 415 Washington, Rolla, KS 67954 | 2015-09-11 |
| 1700064599 | Rolla Eye Clinic | Clinic/Center | 118 3rd St. Ne, Rolla, ND 58367-1170 | 2008-02-05 |
| 1457691305 | Presentation Medical Center | Clinic/Center | 213 2nd Ave Ne, Rolla, ND 58367-7153 | 2013-02-28 |
| 1881819464 | Rolla Urgent Care LLC | Clinic/Center | 1060 S Bishop Ave, Rolla, MO 65401-4411 | 2007-04-17 |
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|---|---|---|---|---|
| 1871102137 | Washington County Memorial Hospital | Clinic/Center | 14206 Hwy C, Belgrade, MO 63622 | 2020-07-23 |
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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.