NPIMap

Organization Active NPI

Physician Groups LC

Doing business as Centralia Family Health Clinic

  • Rural Health Clinic/Center
  • Centralia, MO
National Provider Identifier
1164615316
Registry record updated Sep 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
PHYSICIAN GROUPS LC
Doing business as
Centralia Family Health Clinic
Practice address
1021 E Highway 22
Centralia, MO 65240-1183
Phone
(573) 682-5580
Fax
(573) 682-1539
NPI assigned
Aug 21, 2007
Last updated
Sep 28, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2021

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

Authorized official

Name
Karen Canter-Koester
Title
Vice President/Authorized Official
Phone
(314) 996-7610

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

1021 E Highway 22
Centralia, MO 65240-1183

Mailing address

1600 E Broadway
Columbia, MO 65201-5844
Phone (573) 815-6245

Other names 1

  • Centralia Family Health Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040220001157 MO Part B Supplier - Clinic/Group Practice 3072421254 Receives reassigned benefits from 611 practitioners
44 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 44

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 44

National Provider Directory

National Provider Directory

Locations

1225 Graham Rd
Ste C-2320
Florissant, MO 63031
Phone (314) 953-6801

Ownership & related parties

Change-of-ownership history 1

DateEventCounterparty
Apr 1, 2021 Change of OwnershipThis provider was the seller Centralia Family Health ClinicCCN 268983, MO, NPI 1619648532

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

Practitioners & affiliated clinicians

Practitioners 33

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 33

NPI Registry JSON

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

{
    "created_epoch": "1187654400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632787200000",
    "number": "1164615316",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 E BROADWAY",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652015844",
            "telephone_number": "573-815-6245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1021 E HIGHWAY 22",
            "city": "CENTRALIA",
            "state": "MO",
            "postal_code": "652401183",
            "telephone_number": "573-682-5580",
            "fax_number": "573-682-1539"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICIAN GROUPS LC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-21",
        "last_updated": "2021-09-28",
        "certification_date": "2021-09-28",
        "status": "A",
        "authorized_official_last_name": "CANTER-KOESTER",
        "authorized_official_first_name": "KAREN",
        "authorized_official_title_or_position": "VICE PRESIDENT/AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "314-996-7610"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Centralia Family Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Centralia Family Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Centralia, MO

Sources for this page

Verify at the official NPI Registry.