Pcrmc Medical Group INC

NPI #1093012890 in Rolla, Missouri

Provider Information

NPI Number: 1093012890
Entity Type: Organization
Organization Name: Pcrmc Medical Group INC
Primary Specialty: Podiatrist
Enumeration Date: Feb 15, 2011
Last Updated: Feb 15, 2011

Practice Location

Address: 1050 W 10TH ST
Address 2: STE 420
City: Rolla
State: Missouri
ZIP Code: 65401-2905
Phone: (573) 458-3425

Authorized Official

Name: HAL WAGHER
Title: CORPORATE COMPLIANCE OFFICER
Phone: (573) 458-7615

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X
Podiatrist	213E00000X	Primary

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