Active NPI
Tarkio Hco, LLC
- Skilled Nursing Facility
- Tarkio, MO
National Provider Identifier
1114253127
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- Legal business name
- TARKIO HCO, LLC
- Practice address
- 300 Cedar St
Tarkio, MO 64491-1174 - Phone
- (660) 736-4116
- NPI assigned
- Oct 26, 2009
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mark B. Petersen
- Title
- Manager
- Phone
- (309) 689-5880
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Primary |
Addresses
Primary practice location
300 Cedar St
Tarkio, MO 64491-1174
Mailing address
830 W Trailcreek Dr
Peoria, IL 61614-1862
Other names 1
- Tarkio Rehabilitation & Health Care
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 26D0858828 | Tarkio Rehabilitation & Health Care | Certificate of waiver | Aug 31, 2026 |
National Provider Directory
National Provider DirectoryMember organizations 5
Organizations listed as members of this organization in the National Provider Directory.
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Family Medicine Physician
- Rock Port, MO
- NPI 1245237817
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1256515200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1599004800000",
"number": "1114253127",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "830 W TRAILCREEK DR",
"city": "PEORIA",
"state": "IL",
"postal_code": "616141862"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 CEDAR ST",
"city": "TARKIO",
"state": "MO",
"postal_code": "644911174",
"telephone_number": "660-736-4116"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "TARKIO HCO, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2009-10-26",
"last_updated": "2020-09-02",
"certification_date": "2020-09-02",
"status": "A",
"authorized_official_last_name": "PETERSEN",
"authorized_official_first_name": "MARK",
"authorized_official_middle_name": "B.",
"authorized_official_title_or_position": "MANAGER",
"authorized_official_telephone_number": "309-689-5880"
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Tarkio Rehabilitation & Health Care",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Tarkio Rehabilitation & Health Care",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Tarkio, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.