Ozark Tri-County Health Care Consortium
Organization Active NPI Federally Qualified Health Center (FQHC) · Pineville, MO
NPI 1063178341 · NPPES record last updated Nov 4, 2022
Key facts
- NPI
- 1063178341
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- OZARK TRI-COUNTY HEALTH CARE CONSORTIUM
- Practice address
- 202 E 8TH St
Pineville, MO 64856-9643 - Phone
- (417) 451-9450
- Fax
- (417) 451-8903
- NPI assigned
- Nov 11, 2021
- Organization subpart
- No
Authorized official
- Name
- Donald M McBride
- Title
- Ceo
- Phone
- (417) 451-9450
Owners & managing parties with NPI records 3
Corporate family (same tax ID) 46
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
Federally qualified health center certification: CCN 791174
- Legal name
- OZARK TRI-COUNTY HEALTH CARE CONSORTIUM
- Doing business as
- ACCESS FAMILY CARE
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Jan 6, 2022
- Last certification
- Jan 6, 2022
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Enrollment address
- 202 E 8TH St
Pineville, MO 64856-9643
All disclosed owners & managing parties 21
| Name | Role | Since | Share |
|---|---|---|---|
| Julia M Leibbrand |
W-2 Managing Employee |
Aug 13, 2014 | |
| Robin a Chapman |
Corporate Director |
Feb 23, 2023 | |
| Sheila R Long |
Corporate Officer |
May 14, 2007 | |
| W-2 Managing Employee |
May 14, 2007 | ||
| Amanda K Bearden |
Corporate Director |
Aug 22, 2024 | |
| Keenan T Cortez |
Corporate Director |
Aug 26, 2021 | |
| Jerrie Wise |
Corporate Director |
Jun 15, 1996 | |
| Kala M Smith |
Corporate Officer |
Jul 18, 2011 | |
| W-2 Managing Employee |
Jul 18, 2011 | ||
| Joshua J Shackles |
Corporate Director |
Aug 26, 2021 | |
| Elizabeth Persons |
Corporate Director |
Nov 19, 2009 | |
| John M Seidel |
Corporate Director |
Feb 22, 2024 | |
| Charla J Miles |
Corporate Director |
Aug 22, 2024 | |
| Charles H Bentlage |
Corporate Director |
Jan 28, 2021 | |
| Allison Pruitt |
Corporate Director |
Feb 22, 2024 | |
| Jeffrey Elmore |
Corporate Officer |
May 30, 2017 | |
| W-2 Managing Employee |
May 30, 2017 | ||
| Joseph Zuzul |
Corporate Director |
Jul 25, 2019 | |
| John D Paulson |
Corporate Officer |
Nov 27, 2023 | |
| W-2 Managing Employee |
Nov 27, 2023 | ||
| Christian Demasi |
Corporate Director |
Jul 25, 2014 | |
| Carrie E Foote |
Corporate Officer |
Oct 3, 2021 | |
| W-2 Managing Employee |
Oct 2, 2006 | ||
| Rosario Keele |
Corporate Director |
Feb 22, 2024 | |
| Donald McBride |
Corporate Officer |
Feb 27, 2006 | |
| W-2 Managing Employee |
Feb 27, 2006 | ||
| Carmen K Brown |
Corporate Director |
Mar 25, 2011 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20220104002400 | MO | Part a Provider - Federally Qualified Health Center (FQHC) | 8123918257 | Practice locations: Pineville, MO |
National Provider Directory
- Tax ID family
- Ozark Tri-County Consortium
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
202 E 8TH St
Pineville, MO 64856-9643
Mailing address
PO Box 758
Neosho, MO 64850-0758
Phone (417) 437-8122
Other names
- Access Family Care
Other providers in Pineville, MO
- Kayla Nicole Loving
- Rachael Gabriela McCann
- Gilbert R Morgan
- Gary David Neymeyer
- Tony Hieu Nguyen
- Ozark Tri-County Health Care Consortium
- Tamon Berber Paige
- Teresa N Randolph
- Jill Rogers
- Sgoh Acquisition, Inc.
All providers in Pineville, MO · Federally Qualified Health Center (FQHC) in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 4, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.