Sgoh Acquisition, Inc.
Organization Active NPI Rural Health Clinic/Center · Anderson, MO
NPI 1063969665 · NPPES record last updated Nov 17, 2017
Key facts
- NPI
- 1063969665
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- SGOH ACQUISITION, INC.
- Practice address
- 104 E Main St
Anderson, MO 64831-4103 - Phone
- (417) 845-6984
- NPI assigned
- Sep 1, 2016
- Organization subpart
- No
Authorized official
- Name
- Paul Taylor, JD
- Title
- Ceo
- Phone
- (417) 837-4090
Owners & managing parties with NPI records 15
Owned or controlled facilities with NPI records 14
Other NPIs with the same Medicare PAC ID 15
Corporate family (same tax ID) 7
Related certifications (CCN) 1
Facilities with the same owner 14
Practitioners 95
-
Shannon Alvarez, FNP
-
Steven R Barnes, FNP
-
Jackie Beene, MD
-
Angela R Bridges, NP-CO
-
Janiece Rachelle Bridges, M.D.
-
Sunshine Leeann Bunch, FNP-C
-
Linda C Burdett, FNP
-
Jessica Burks, FNP-C
-
John Stephen Carpenter, MSW, LCSW
-
Fernando Cavero, M.D.
-
Robin L Cavero, FNP
-
Amanda J Chapman, MSN-NP
-
Arthur Joe Cohn, DO
-
Latoya M. Compton, FNP
-
Justin Lee Cope, APRN
-
Coral L Couchenour, D.O.
-
Zachary Edward Dampier, MSN, APRN, PMHNP-BC
-
Bonnie Janeen Daniel, FNP-C
-
Lorri Jean Darrow, MD, PSYD
-
Frederick M. Faust, M.D.
-
Jerald Delbert Forsyth, PSY.D.
-
Tyler Gammon, DO
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AR
Rural health clinic certification: CCN 268747
- Legal name
- SGOH ACQUISITION INC
- Doing business as
- OCH ANDERSON RURAL HEALTH CLINIC
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Feb 28, 1994
- Last certification
- May 14, 2026
- Ownership / control type
- 2B
- Most recent change of ownership
- Jan 1, 2017 (1 total)
- Organization structure
- Corporation · Proprietary
- Incorporated
- Aug 21, 1991 in MO
- Enrollment address
- 104 E Main St
Anderson, MO 64831-4103 - Related CCNs
- 041331
All disclosed owners & managing parties 2
| Name | Role | Since | Share |
|---|---|---|---|
| Paul G Taylor |
Corporate Director |
Jan 1, 2017 | 100% |
| W-2 Managing Employee |
Jan 1, 2017 | 100% | |
| Sgoh Acquisition Inc |
5% Or Greater Direct Ownership Interest | Jan 1, 2017 | 100% |
All facility ownership & control disclosures 14
| Facility | Type | Role | Since |
|---|---|---|---|
| Ozarks Community Hospital of Gravette |
Hospital | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control |
May 16, 2008 Dec 31, 2021 |
| Ozarks Community Hospital of Gravette |
Hospital | Operational/Managerial Control (100%) | Dec 31, 2021 |
| Och McDonald County Clinic |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Dec 19, 2013 |
| Och Sparta Clinic |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Nov 1, 2014 |
| Och Lawrence County Clinic |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Jan 1, 2015 |
| Och Wellpointe Family Medical Clinic |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Jan 1, 2015 |
| Och Jasper County Clinic Carthage Campus |
Rural health clinic | 5% Or Greater Direct Ownership Interest | Jan 1, 2015 |
| Och Pineville Medical Clinic |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Jan 1, 2017 |
| Och Southwest City Community Clinic |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Jan 1, 2017 |
| Och Goodman Family Clinic |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Jan 1, 2017 |
| Och Newton County Clinic |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Jan 1, 2020 Jan 1, 2020 |
| Sgoh Acquisition Inc |
Rural health clinic | 5% Or Greater Direct Ownership Interest Operational/Managerial Control (100%) |
Aug 1, 2020 Aug 1, 2020 |
| Och Webster County Clinic |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Jan 1, 2015 |
| Sgoh Acquisition Inc |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Aug 5, 2024 Aug 5, 2024 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20170207000588 | AR | Part a Provider - Rural Health Clinic | 5092616276 | Practice locations: Anderson, MO |
National Provider Directory
- Tax ID family
- John D Mackie DO
Locations
135 N Roy Hill Blvd
Goodman, MO 64843
Phone (417) 364-4060
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
104 E Main St
Anderson, MO 64831-4103
Mailing address
104 E Main St
Anderson, MO 64831-4103
Phone (417) 845-6984
Other providers in Anderson, MO
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- Gladys Kabamba Smith
- Kathryn Smith
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All providers in Anderson, MO · Rural Health Clinic/Center 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 17, 2017. 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.