FCC Medical Clinics LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

FCC MEDICAL CLINICS LLC

Practice address

3001 Warrior LN
Poplar Bluff, MO 63901-8685

Phone

(573) 686-1200

Fax

(573) 778-9492

NPI assigned

May 4, 2021

Organization subpart

Yes

Parent organization

FAMILY COUNSELING CENTER, INC.As reported in NPPES

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

Authorized official

Name

Tracy Ellis

Title

Cco

Phone

(573) 888-5925

Specialties & licenses 2

Addresses

Other names 1

• FCC Primary Care Clinic Poplar Bluff Doing business as

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

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

• FCC Medical Clinics LLC

  • Rural Health Clinic/Center
  • Kennett, MO
  • NPI 1043885254

  O20210707003258

  Same enrollment

Tax ID family

FCC Medical Clinics LLC2 organizations share this tax ID, including this one

Part of

Family Counseling Cente

Other organizations with this tax ID 1

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

• FCC Medical Clinics LLC

  • Clinic/Center
  • Kennett, MO
  • NPI 1063081263
  NPD tax ID

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

{
    "created_epoch": "1620086400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626048000000",
    "number": "1215510490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 71",
            "city": "KENNETT",
            "state": "MO",
            "postal_code": "638570071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3001 WARRIOR LN",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639018685",
            "telephone_number": "573-686-1200",
            "fax_number": "573-778-9492"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FCC MEDICAL CLINICS LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FAMILY COUNSELING CENTER, INC.",
        "enumeration_date": "2021-05-04",
        "last_updated": "2021-07-12",
        "certification_date": "2021-07-12",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "TRACY",
        "authorized_official_title_or_position": "CCO",
        "authorized_official_telephone_number": "573-888-5925"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FCC Primary Care Clinic Poplar Bluff",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "FCC Primary Care Clinic Poplar Bluff",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• David Farris, R.PH.
• Mary Farris
• Bonnie Sue Faughn
• Tammie Faughn, B.S.
• Andrew Charles Faulkner
• Brook Fears
• James Feece, BS,CSS
• Brandon Tyler Felps
• Carmella Fenske, CRADC
• Melissa Ferguson

• Internal Medicine Physician in Poplar Bluff, MO
• Providers in Poplar Bluff, MO by specialty
• Internal Medicine Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.