Provider Demographics
NPI:1063969665
Name:SGOH ACQUISITION, INC.
Entity type:Organization
Organization Name:SGOH ACQUISITION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:417-837-4090
Mailing Address - Street 1:104 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:MO
Mailing Address - Zip Code:64831-4103
Mailing Address - Country:US
Mailing Address - Phone:417-845-6984
Mailing Address - Fax:
Practice Address - Street 1:104 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:MO
Practice Address - Zip Code:64831-4103
Practice Address - Country:US
Practice Address - Phone:417-845-6984
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2017-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health