Provider Demographics
NPI:1265684476
Name:SACRY FAMILY MEDICINE PC
Entity Type:Organization
Organization Name:SACRY FAMILY MEDICINE PC
Other - Org Name:SACRY FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:SACRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:417-388-2746
Mailing Address - Street 1:433 S GARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:MO
Mailing Address - Zip Code:64836-1749
Mailing Address - Country:US
Mailing Address - Phone:417-359-8646
Mailing Address - Fax:
Practice Address - Street 1:433 S GARRISON AVE
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:MO
Practice Address - Zip Code:64836-1749
Practice Address - Country:US
Practice Address - Phone:417-359-8646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1999134577261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care