Provider Demographics
NPI:1851845093
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 1:565 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:NEW MADRID
Practice Address - State:MO
Practice Address - Zip Code:63869-1753
Practice Address - Country:US
Practice Address - Phone:573-471-0330
Practice Address - Fax:573-481-5019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-04
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty