NPIMap

Organization Active NPI

South Central Missouri Community Health Center

Doing business as Four Rivers Pharmacy

  • Community/Retail Pharmacy
  • Rolla, MO
National Provider Identifier
1245094226
Registry record updated May 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
SOUTH CENTRAL MISSOURI COMMUNITY HEALTH CENTER
Doing business as
Four Rivers Pharmacy
Practice address
1081 E 18TH St
Rolla, MO 65401-2448
Phone
(573) 426-4455
Fax
(573) 426-6723
NPI assigned
Feb 9, 2024
Last updated
May 15, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 15, 2024

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

Authorized official

Name
Elizabeth Sparks
Title
HR Manager
Phone
(573) 426-2407

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X NU Primary

Addresses

Primary practice location

1081 E 18TH St
Rolla, MO 65401-2448

Mailing address

1081 E 18TH St
Rolla, MO 65401-2448
Phone (573) 426-4455

Other names 1

  • Four Rivers Pharmacy Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250918001895 MO Part B Supplier - Pharmacy 1355513581 1 other NPI on this enrollment
Practice locations: Rolla, MO; Salem, MO

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
South Central Mo Center13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

Locations

1081 E 18th St
#Four
Rolla, MO 65401
Phone (573) 633-5083

Ownership & related parties

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Your Community Health CenterRolla, MO, CCN 261070 Federally qualified health center Operational/Managerial Control (100%) Sep 1, 2014
Four Rivers Community Health CenterRolla, MO, CCN 791034 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 11, 2023

Owned or controlled facilities with NPI records 2

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

NPI Registry JSON

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

{
    "created_epoch": "1707436800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715731200000",
    "number": "1245094226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1081 E 18TH ST",
            "city": "ROLLA",
            "state": "MO",
            "postal_code": "654012448",
            "telephone_number": "573-426-4455",
            "fax_number": "573-426-6723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1081 E 18TH ST",
            "city": "ROLLA",
            "state": "MO",
            "postal_code": "654012448",
            "telephone_number": "573-426-4455",
            "fax_number": "573-426-6723"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH CENTRAL MISSOURI COMMUNITY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-09",
        "last_updated": "2024-05-15",
        "certification_date": "2024-03-15",
        "status": "A",
        "authorized_official_last_name": "SPARKS",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_title_or_position": "HR MANAGER",
        "authorized_official_telephone_number": "573-426-2407"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Four Rivers Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Four Rivers Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rolla, MO

Sources for this page

Verify at the official NPI Registry.