Northeast Missouri Health Council, Inc.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

2001023603 Issued in MO

Legal business name

NORTHEAST MISSOURI HEALTH COUNCIL, INC.

Doing business as

Northeast Missouri Family Health Clinic

Practice address

RR 1 Box 55
Sigler Avenue
Memphis, MO 63555-9726

Phone

(660) 465-7037

Fax

(660) 465-7350

NPI assigned

Jan 29, 2007

Last updated

Apr 1, 2009By the provider in NPPES

Organization subpart

Yes

Parent organization

NORTHEAST MISSOURI HEALTH COUNCIL, INC.As reported in NPPES

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

Authorized official

Name

Andrew H. Grimm

Title

Executive Director

Phone

(660) 627-5757

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Northeast Missouri Family Health Clinic Doing business as

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Other NPIs on the same Medicare enrollment 4

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

• Northeast Missouri Health Council Inc

  dba Memphis Community Health Center

  • Internal Medicine Physician
  • Memphis, MO
  • NPI 1881307155

  O20040107000173

  Same enrollment
• Northeast Missouri Health Council, Inc

  dba Macon Family Health

  • Federally Qualified Health Center (FQHC)
  • Macon, MO
  • NPI 1487038881

  O20040107000173

  Same enrollment
• Northeast Missouri Health Council, Inc.

  dba Northeast Family Health Clinics

  • Federally Qualified Health Center (FQHC)
  • Kirksville, MO
  • NPI 1104829498

  O20040107000173

  Same enrollment
• Northeast Missouri Health Council, Inc.

  dba Northeast Missouri Family Health Clinic

  • Federally Qualified Health Center (FQHC)
  • Edina, MO
  • NPI 1881730893

  O20040107000173

  Same enrollment

Part of

Northeast Missouri Fami

Practitioners 1

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.

• Jeffrey D Davis, DO

  • Family Medicine Physician
  • Memphis, MO
  • NPI 1679558589
  NPD (past)

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

{
    "created_epoch": "1170028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1238544000000",
    "number": "1235275249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "314 E MCPHERSON ST",
            "city": "KIRKSVILLE",
            "state": "MO",
            "postal_code": "635013557",
            "telephone_number": "660-627-5757",
            "fax_number": "660-627-5802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "RR 1 BOX 55",
            "address_2": "SIGLER AVENUE",
            "city": "MEMPHIS",
            "state": "MO",
            "postal_code": "635559726",
            "telephone_number": "660-465-7037",
            "fax_number": "660-465-7350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST MISSOURI HEALTH COUNCIL, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NORTHEAST MISSOURI HEALTH COUNCIL, INC.",
        "enumeration_date": "2007-01-29",
        "last_updated": "2009-04-01",
        "status": "A",
        "authorized_official_last_name": "GRIMM",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_middle_name": "H.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "660-627-5757"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MO",
            "license": "076376",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2001023603",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "503351827",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northeast Missouri Family Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kaitlyn Nicole McMinn
• Hossain Mesbah, MD
• Celeste Marie Miller-Parish, D.O
• Darrell Lynn Monroe, DC
• Northeast Missouri Health Council Inc (Memphis Community Health Center)
• Susanne Renee Owens, CRNA
• Kylee Nichole Perkins, PTA
• Lisa Marie Peterson, LCSW
• Pkanesthesia, Inc
• Kenneth Bruce Quenneville, MD

• Family Medicine Physician in Memphis, MO
• Providers in Memphis, MO by specialty
• Family Medicine Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2009; 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.