NPIMap

Organization Active NPI

Bonne Terre Health Clinic LLC

  • Rural Health Clinic/Center
  • Bonne Terre, MO
National Provider Identifier
1104071935
Registry record updated Sep 24, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
102387 Issued in MO
Legal business name
BONNE TERRE HEALTH CLINIC LLC
Practice address
55 Nesbit Dr
Bonne Terre, MO 63628-1353
Phone
(573) 358-3343
Fax
(573) 358-5458
NPI assigned
Nov 20, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Andrew John Ninichuck, M.D.
Title
Member
Phone
(573) 358-3343

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 102387 MO
Rural Health Clinic/Center 261QR1300X 102387 MO Primary

Addresses

Primary practice location

55 Nesbit Dr
Bonne Terre, MO 63628-1353

Mailing address

55 Nesbit Dr
Bonne Terre, MO 63628-1353
Phone (573) 358-3343

National Provider Directory

National Provider Directory

Locations

30 N Allen St
Bonne Terre, MO 63628
Phone (573) 358-3343

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1227139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1253750400000",
    "number": "1104071935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 NESBIT DR",
            "city": "BONNE TERRE",
            "state": "MO",
            "postal_code": "636281353",
            "telephone_number": "573-358-3343",
            "fax_number": "573-358-5458"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 NESBIT DR",
            "city": "BONNE TERRE",
            "state": "MO",
            "postal_code": "636281353",
            "telephone_number": "573-358-3343",
            "fax_number": "573-358-5458"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BONNE TERRE HEALTH CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-20",
        "last_updated": "2009-09-24",
        "status": "A",
        "authorized_official_last_name": "NINICHUCK",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "573-358-3343",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "102387",
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "MO",
            "license": "102387",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bonne Terre, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.