NPIMap

Organization Active NPI

Washington County Memorial Hospital

Doing business as WCMH Urgent Care Clinic

  • Rural Health Clinic/Center
  • Potosi, MO
National Provider Identifier
1205064532
Registry record updated Aug 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
WASHINGTON COUNTY MEMORIAL HOSPITAL
Doing business as
WCMH Urgent Care Clinic
Practice address
300 Health Way Dr
Potosi, MO 63664-1420
Phone
(573) 438-5451
NPI assigned
Jun 25, 2009
Last updated
Aug 27, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2020

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

Authorized official

Name
Mrs. Debra A Pratt
Title
Cfo
Phone
(573) 438-5451

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

300 Health Way Dr
Potosi, MO 63664-1420

Mailing address

300 Health Way Dr
Potosi, MO 63664-1420
Phone (573) 438-5451

Other identifiers 1

IdentifierTypeStateIssuer
594426207MedicaidMO

Other names 1

  • WCMH Urgent Care Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091012000205 MO Part A Provider - Rural Health Clinic 3476456880 Practice locations: Potosi, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1205064532. Details of each certification follow.

Rural health clinic certification: CCN 268650

Legal name
WASHINGTON COUNTY MEMORIAL HOSPITAL
Doing business as
WCMH URGENT CARE CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 6, 2010
Last certification
Oct 3, 2023
Ownership / control type
Non-profit – church related
Organization structure
GovernmentNon-profit
Enrollment address
300 Health Way Dr
Potosi, MO 63664-1420
Related CCNs
261308

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
26D2001295WCMH Urgent Care300 Health Way Dr, Potosi, MO 63664Certificate of waiverSep 30, 2027

National Provider Directory

National Provider Directory
Tax ID family
Washington County Memor8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Washington County Memorial Hospital Organization, Potosi, MO Operational/Managerial Control Jan 1, 2009 100%
Melvin a Warden Individual Corporate OfficerBoard Member Apr 17, 1995
Debra a Pratt Individual W-2 Managing EmployeeCfo Oct 28, 2016
Operational/Managerial ControlCfo Oct 28, 2016

Owners & managing parties with NPI records 5

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 5

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Washington County Memorial HospitalPotosi, MO, CCN 261308 Hospital Other (100%) Dec 1, 1963
Washington County Memorial HospitalPotosi, MO, CCN 26Z308 Hospital Other (100%) Dec 1, 1963
Austin Plaza Primary CarePotosi, MO, CCN 268505 Rural health clinic 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Jun 1, 2001
Jun 1, 2001
Healthway Primary CarePotosi, MO, CCN 263410 Rural health clinic 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Jun 1, 2001
Jun 1, 2001
Potosi Rural Health ClinicPotosi, MO, CCN 268651 Rural health clinic Operational/Managerial Control Aug 30, 2010

Owned or controlled facilities with NPI records 5

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 3

Facilities that share an organizational owner with 5% or greater ownership or operational control.

NPI Registry JSON

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

{
    "created_epoch": "1245888000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598486400000",
    "number": "1205064532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 HEALTH WAY DR",
            "city": "POTOSI",
            "state": "MO",
            "postal_code": "636641420",
            "telephone_number": "573-438-5451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 HEALTH WAY DR",
            "city": "POTOSI",
            "state": "MO",
            "postal_code": "636641420",
            "telephone_number": "573-438-5451"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WASHINGTON COUNTY MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-25",
        "last_updated": "2020-08-27",
        "certification_date": "2020-08-27",
        "status": "A",
        "authorized_official_last_name": "PRATT",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "573-438-5451",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "594426207",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WCMH Urgent Care Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "WCMH Urgent Care Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Potosi, MO

Sources for this page

Verify at the official NPI Registry.