Provider Demographics
NPI:1154563559
Name:PROFESSIONAL CLINICS LLC
Entity type:Organization
Organization Name:PROFESSIONAL CLINICS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:NAEGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-547-3232
Mailing Address - Street 1:624 OLD SAINT MARYS RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:PERRYVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63775-1837
Mailing Address - Country:US
Mailing Address - Phone:573-547-3232
Mailing Address - Fax:573-547-3231
Practice Address - Street 1:624 OLD SAINT MARYS RD
Practice Address - Street 2:SUITE A
Practice Address - City:PERRYVILLE
Practice Address - State:MO
Practice Address - Zip Code:63775-1837
Practice Address - Country:US
Practice Address - Phone:573-547-3232
Practice Address - Fax:573-547-3231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-31
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty