| Organization Name: | MOUNTAIN GROVE MEDICAL AND LASER CENTER P.C. |
| NPI Number: | 1053760769 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DOYLE HILL (OWNER) |
| Mailing Address: | 601 N Busch Ave Mountain Grove |
| State: | MO US |
| Postal Code: | 657111415 |
| Phone Number: | 4179266643 |
| Fax Number: | |
| NPI Enumeration Date: | 06/03/2016 |
| NPI Last Update Date: | 06/03/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |