Family Medicine Of Jefferson City, Llc | |
1616 Southridge Dr Suite #203 Jefferson City MO 65109-5677 | |
(573) 659-7300 | |
(573) 636-0555 |
Full Name | Family Medicine Of Jefferson City, Llc |
---|---|
Speciality | Family Medicine |
Location | 1616 Southridge Dr, Jefferson City, Missouri |
Authorized Official Name and Position | Daniel P Lavery (OWNER/PRESIDENT) |
Authorized Official Contact | 5736597300 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Family Medicine Of Jefferson City, Llc 1616 Southridge Dr Suite #203 Jefferson City MO 65109-5677 Ph: (573) 659-7300 | Family Medicine Of Jefferson City, Llc 1616 Southridge Dr Suite #203 Jefferson City MO 65109-5677 Ph: (573) 659-7300 |
NPI Number | 1043319957 |
---|---|
Provider Enumeration Date | 09/21/2006 |
Last Update Date | 08/22/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1043319957 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | R9J28 (Missouri) | Primary |
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