| Organization Name: | PCRMC MEDICAL GROUP INC |
| NPI Number: | 1093012890 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | HAL WAGHER (CORPORATE COMPLIANCE OFFICER) |
| Mailing Address: | 1050 W 10th St Ste 420 Rolla |
| State: | MO US |
| Postal Code: | 654012905 |
| Phone Number: | 5734583425 |
| Fax Number: | 5734262282 |
| NPI Enumeration Date: | 02/15/2011 |
| NPI Last Update Date: | 02/15/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | MODOR4D88 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MO |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |