Family Health and Wellness Clinic, LLC
Organization Active NPI Family Medicine Physician · Liberal, MO
NPI 1215436696 · NPPES record last updated Dec 31, 2020
Key facts
- NPI
- 1215436696
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- FAMILY HEALTH AND WELLNESS CLINIC, LLC
- Practice address
- 138 S Main St
Liberal, MO 64762-9314 - Phone
- (417) 843-2008
- NPI assigned
- Feb 12, 2018
- Organization subpart
- No
Authorized official
- Name
- Carla Michelle Reed, FNP-BC
- Title
- Member/FNP-BC
- Phone
- (573) 569-2046
Practitioners 2
-
Judy M Parton, MD
-
Carla Reed, FNP-BC
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 26D2144723 | Family Health and Wellness Clinic, LLC | Certificate of waiver | Feb 21, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180404002108 | MO | Part B Supplier - Clinic/Group Practice | 2163785106 |
Receives reassigned benefits from 2 practitioners Practice locations: Liberal, MO |
National Provider Directory
Interoperability endpoints
- https://api.platform.athenahealth.com/22024/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
138 S Main St
Liberal, MO 64762-9314
Mailing address
PO Box 13
Liberal, MO 64762-0013
Phone (573) 569-2046
Other providers in Liberal, MO
- Tamarra Michelle Butcher
- Denise Elaine Dickens
- Inez Shields LLC
- Robert R Jones
- Judy M Parton
- Carla Reed
- Regional Services
All providers in Liberal, MO · Family Medicine Physician in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 31, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.