Provider Demographics
NPI:1164615316
Name:PHYSICIAN GROUPS LC
Entity Type:Organization
Organization Name:PHYSICIAN GROUPS LC
Other - Org Name:CENTRALIA FAMILY HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:CANTER-KOESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-996-7610
Mailing Address - Street 1:1600 E BROADWAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-5844
Mailing Address - Country:US
Mailing Address - Phone:573-815-6245
Mailing Address - Fax:
Practice Address - Street 1:1021 E HIGHWAY 22
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:MO
Practice Address - Zip Code:65240-1183
Practice Address - Country:US
Practice Address - Phone:573-682-5580
Practice Address - Fax:573-682-1539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care