Provider Demographics
NPI:1467518464
Name:EASTERN MISSOURI GENERAL SERVICES INC
Entity Type:Organization
Organization Name:EASTERN MISSOURI GENERAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:RIOHARD
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:SECOR
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:573-431-4510
Mailing Address - Street 1:322 NO STATE STREET
Mailing Address - Street 2:
Mailing Address - City:DESLOGE
Mailing Address - State:MO
Mailing Address - Zip Code:63601-3052
Mailing Address - Country:US
Mailing Address - Phone:573-431-4510
Mailing Address - Fax:573-431-4790
Practice Address - Street 1:322 NO STATE STREET
Practice Address - Street 2:
Practice Address - City:DESLOGE
Practice Address - State:MO
Practice Address - Zip Code:63601-3052
Practice Address - Country:US
Practice Address - Phone:573-431-4510
Practice Address - Fax:573-431-4790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR9A44207Q00000X
MS10179207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0130013OtherUNITED HEALTH CARE
MO101430OtherHL HEALTHLINK
103OtherGHP GROUP HEALTH PLAN
MO04232001OtherAETNA
MO25000OtherBCBS
4384846OtherAETNA
103OtherGHP GROUP HEALTH PLAN