Provider Demographics
NPI:1225225675
Name:FERGUSON MEDICAL GROUP RURAL HEALTH CENTER, INC
Entity Type:Organization
Organization Name:FERGUSON MEDICAL GROUP RURAL HEALTH CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:SHILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-471-0330
Mailing Address - Street 1:PO BOX 1068
Mailing Address - Street 2:
Mailing Address - City:SIKESTON
Mailing Address - State:MO
Mailing Address - Zip Code:63801-1068
Mailing Address - Country:US
Mailing Address - Phone:573-471-0330
Mailing Address - Fax:573-481-5019
Practice Address - Street 1:115 E BUSINESS US HIGHWAY 60
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:MO
Practice Address - Zip Code:63841-1219
Practice Address - Country:US
Practice Address - Phone:573-614-5007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO18011OtherBLUE CROSS BLUE SHIELD
MO000010802Medicare PIN