Provider Demographics
NPI:1942335203
Name:SGOH ACQUISITION INC
Entity Type:Organization
Organization Name:SGOH ACQUISITION INC
Other - Org Name:OCH WEBSTER COUNTY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:G
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-837-4000
Mailing Address - Street 1:101 SOUTH MAIN
Mailing Address - Street 2:
Mailing Address - City:ROGERSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65742
Mailing Address - Country:US
Mailing Address - Phone:417-753-9404
Mailing Address - Fax:417-753-9137
Practice Address - Street 1:101 SOUTH MAIN
Practice Address - Street 2:
Practice Address - City:ROGERSVILLE
Practice Address - State:MO
Practice Address - Zip Code:65742
Practice Address - Country:US
Practice Address - Phone:417-753-9404
Practice Address - Fax:417-753-9137
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SGOH ACQUISITION INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-23
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO598387306Medicaid
MO268609Medicare Oscar/Certification