JEFFERSON PHYSICIAN NETWORK, LLC (NPI# 1568734994) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1568734994 |
| Entity Type | Organization |
| Organization Name | JEFFERSON PHYSICIAN NETWORK, LLC |
| Practice Address |
1105 W Liberty St Farmington MO 63640-1921 |
| Mailing Address |
Po Box 350 Crystal City MO 63019-0350 |
| Practice Telephone | 6369332900 |
| Practice Fax Number | 6369338017 |
| Mailing Telephone | 6369331299 |
| Mailing Fax Number | 6369338017 |
| Enumeration Date | 2012-02-01 |
| Last Update Date | 2012-02-01 |
| Authorized Official Name | MR. JEFF BUCK (INTERIEM CHIEF EXECUTIVE OFFICER) |
| Authorized Official Telephone | 6369331000 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207RE0101X |
Internal Medicine Specialization: Endocrinology, Diabetes & Metabolism |
2010010722 | MO | Allopathic & Osteopathic Physicians |
| N | 207RR0500X |
Internal Medicine Specialization: Rheumatology |
2009017530 | MO | Allopathic & Osteopathic Physicians |
| Y | 207RE0101X |
Internal Medicine Specialization: Endocrinology, Diabetes & Metabolism |
2009008025 | MO | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | NPI | 1558508606 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558508606 | Jefferson Physician Network, LLC | Surgery | 1400 Highway 61, Suite 240, Festus, MO 63028-4100 | 2009-01-12 |
| Street Address |
1105 W LIBERTY ST |
| City | FARMINGTON |
| State | MO |
| Zip Code | 63640-1921 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639151657 | Myra Lyn Menjoulet | Nurse Practitioner | 1105 W Liberty St, Suite 3002, Farmington, MO 63640-1921 | 2005-11-16 |
| 1023432788 | Womack Counseling Services LLC | Social Worker | 1105 W Liberty St, Suite 4050, Farmington, MO 63640-1921 | 2014-02-14 |
| 1740505197 | James Preston Womack | Social Worker | 1105 W Liberty St, Suite 4050, Farmington, MO 63640-1921 | 2010-03-29 |
| 1336264613 | Parkland Women's Health, PC | Obstetrics & Gynecology | 1105 W Liberty St, Ste 4020, Farmington, MO 63640-1921 | 2007-03-19 |
| 1619059417 | Avalon Obstetrics and Gynecology, P.C. | Obstetrics & Gynecology | 1105 W Liberty St, Suite 2050, Farmington, MO 63640-1921 | 2006-10-20 |
| 1780789206 | Madonna Weiss | Nurse Practitioner | 1105 W Liberty St, Suite 4050, Farmington, MO 63640-1921 | 2006-09-13 |
| 1437135241 | Julie M Koppeis Mctearnen | Nurse Practitioner | 1105 W Liberty St, Suite 4050, Farmington, MO 63640-1921 | 2005-12-22 |
| 1013993476 | Parkland Health Clinic | Family Medicine | 1105 W Liberty St, Ste 4050, Farmington, MO 63640-1921 | 2005-12-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316545254 | Brenda S Halton | Nurse Practitioner | 1010 West Columbia Street, Farmington, MO 63640 | 2020-10-13 |
| 1619519089 | Stacey Nicole Gillette | Counselor | 17885 Hart Pinkston Rd, Farmington, MO 63640 | 2019-10-17 |
| 1346890696 | Christopher Ryan Massey | Social Worker | 607 Pine St., Farmington, MO 63640 | 2019-09-18 |
| 1457909376 | Clarice Ogden | Social Worker | 203 South Washington Street, Farmington, MO 63640 | 2019-09-04 |
| 1861979718 | Clint Thebeau | In Home Supportive Care | 1276 W Liberty St, Farmington, MO 63640 | 2018-07-24 |
| 1023500600 | Lynn Machelle Knox | Counselor | 219 W Columbia St, Farmington, MO 63640 | 2018-05-31 |
| 1235620576 | Kim Bazzell | Registered Nurse | 1565 Ste. Genevieve Ave., Farmington, MO 63640 | 2018-05-22 |
| 1164919742 | Lincare Inc. | Durable Medical Equipment & Medical Supplies | 774 Market St, Farmington, MO 63640 | 2018-04-18 |
| 1184127813 | Michelle Lynette Corvallis | Chiropractor | 17 South Franklin St., Farmington, MO 63640 | 2018-03-08 |
| 1992206213 | Farmington Vision Care LLC | Optometrist | 110 E Harrison St, Farmington, MO 63640 | 2018-02-22 |
| Find all providers in zip 63640 | ||||
| Taxonomy Code | 207RE0101X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Endocrinology, Diabetes & Metabolism |
| An internist who concentrates on disorders of the internal (endocrine) glands such as the thyroid and adrenal glands. This specialist also deals with disorders such as diabetes, metabolic and nutritional disorders, obesity, pituitary diseases and menstrual and sexual problems. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770533788 | Robert E Burr | Internal Medicine | 407 S Schwartz Ave Ste 201, Farmington, NM 87401 | 2006-05-11 |
| 1235190562 | Thomas Gordon Jones | Internal Medicine | 1027 Farmington Avenue, Farmington, CT 06032-1511 | 2006-03-28 |
| 1487086625 | Fatima Jalil | Internal Medicine | 263 Farmington Ave, Farmington, CT 06030 | 2013-07-30 |
| 1679739684 | Navneet Kainth | Internal Medicine | 407 S Schwartz Ave, Suite 201, Farmington, NM 87401-5925 | 2008-07-30 |
| 1104008408 | State of Connecticut Health Center | Internal Medicine | 263 Farmington Ave, Endrocrinology Associates, Farmington, CT 06030-0001 | 2007-11-29 |
| 1386709558 | David W. Rowe | Internal Medicine | John Dempsey Hospital, 263 Farmington Avenue, Mc-1231, Farmington, CT 06030-0001 | 2006-12-27 |
| 1134284516 | Marja M. Hurley | Internal Medicine | John Dempsey Hospital, 263 Farmington Avenue, Mc-3920, Farmington, CT 06030-0001 | 2006-12-26 |
| 1902914724 | Vitaly Kantorovich | Internal Medicine | 263 Farmington Ave, Farmington, CT 06030-5351 | 2006-08-29 |
| 1306854997 | Faryal Sardar Mirza | Internal Medicine | 263 Farmington Ave, Uconn Medical Group/endocrinology Associates, Farmington, CT 06030-0001 | 2006-08-03 |
| 1417941782 | Pooja Luthra | Internal Medicine | 263 Farmington Ave, Farmington, CT 06030-0001 | 2005-09-01 |
| Find all providers in FARMINGTON | ||||
| City | FARMINGTON |
| Zip Code | 63640 |
Please comment or provide details below to improve the information on JEFFERSON PHYSICIAN NETWORK, LLC.
| 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.