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Physician Groups LC

Organization Active NPI Rural Health Clinic/Center · Centralia, MO

NPI 1164615316 · NPPES record last updated Sep 28, 2021

Key facts

NPI
1164615316
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
Legal business name
PHYSICIAN GROUPS LC
Practice address
1021 E Highway 22
Centralia, MO 65240-1183
Phone
(573) 682-5580
Fax
(573) 682-1539
NPI assigned
Aug 21, 2007
Organization subpart
No

Authorized official

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

Other NPIs on the same Medicare enrollment 44

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

View all 44

Change of ownership 1

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

Practitioners 33

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

View all 33

Medicare participation

Medicare fee-for-service enrollment
Enrolled in MO

Change-of-ownership history

DateEventCounterparty
Apr 1, 2021 Change of Ownership
This provider was the seller		 Centralia Family Health Clinic
CCN 268983 · MO · NPI 1619648532

Medicare enrollment records

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

National Provider Directory

Locations

6261 Ronald Reagan Dr
Ste B19
Lake St Louis, MO 63367
Phone (636) 561-3021

11125 Dunn Rd
Ste 406
Saint Louis, MO 63136
Phone (314) 355-4010

Specialties & licenses

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

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

  • Centralia Family Health Clinic Doing business as

Other providers in Centralia, MO

All providers in Centralia, MO · Rural Health Clinic/Center in Missouri

Sources for this page

Verify at the official NPI Registry.