Organization Name: | OGMC LLC |
NPI Number: | 1104916337 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | STEVE T GIALDE (PARTNER) |
Mailing Address: | 1900 S Broadway Oak Grove |
State: | MN US |
Postal Code: | 64075 |
Phone Number: | 8166906566 |
Fax Number: | 8166258276 |
NPI Enumeration Date: | 10/16/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |