Provider Demographics
NPI:1245212133
Name:JOSEPH E. PEHLMAN
Entity Type:Organization
Organization Name:JOSEPH E. PEHLMAN
Other - Org Name:JOSEPH E PEHLMAN FAMILY CLINIC LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:E
Authorized Official - Last Name:PEHLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:573-276-3884
Mailing Address - Street 1:PO BOX 526
Mailing Address - Street 2:1207 NORTH DOUGLASS STREET
Mailing Address - City:MALDEN
Mailing Address - State:MO
Mailing Address - Zip Code:63863-0526
Mailing Address - Country:US
Mailing Address - Phone:573-276-3884
Mailing Address - Fax:573-276-3885
Practice Address - Street 1:1207 N DOUGLASS ST
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MO
Practice Address - Zip Code:63863-1351
Practice Address - Country:US
Practice Address - Phone:573-276-3884
Practice Address - Fax:573-276-3885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-16
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD595057308Medicaid
263895Medicare ID - Type UnspecifiedRHC PROVIDER NUMBER