Organization Name: | MOUNTAIN GROVE MEDICAL AND LASER CENTER PC |
NPI Number: | 1972573699 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DOYLE B HILL (PRESIDENT) |
Mailing Address: | 601 N Busch Ave Mountain Grove |
State: | MO US |
Postal Code: | 657111415 |
Phone Number: | 4179266643 |
Fax Number: | 4179266317 |
NPI Enumeration Date: | 01/25/2006 |
NPI Last Update Date: | 05/24/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | R7130 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MO |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |