Active NPI
South Central Missouri Community Health Center
- Family Medicine Physician
- Rolla, MO
National Provider Identifier
1255867479
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- SOUTH CENTRAL MISSOURI COMMUNITY HEALTH CENTER
- Practice address
- 200 N Main St
Suite 51G
Rolla, MO 65401-3061 - Phone
- (573) 426-6712
- Fax
- (573) 426-6735
- NPI assigned
- May 9, 2017
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Kelly Miller
- Title
- Ceo
- Phone
- (573) 426-6712
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | Primary |
Addresses
Primary practice location
200 N Main St
Suite 51G
Rolla, MO 65401-3061
Mailing address
200 N Main St
Suite 51G
Rolla, MO 65401-3061
Phone (573) 426-6712
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164669172 | Medicaid | MO |
Other names 1
- Your Community Health Center
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
Federally qualified health center certification: CCN 261137
Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.
- Legal name
- YOUR COMMUNITY HEALTH CENTER AT PCHD
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Jun 30, 2017
- Last certification
- Jun 30, 2017
- Ownership / control type
- Non-profit – church related
- Facility address
- 200 North Main Street
Rolla, MO 65401
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1494288000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1494288000000",
"number": "1255867479",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 N MAIN ST",
"address_2": "SUITE 51G",
"city": "ROLLA",
"state": "MO",
"postal_code": "654013061",
"telephone_number": "573-426-6712",
"fax_number": "573-426-6735"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 N MAIN ST",
"address_2": "SUITE 51G",
"city": "ROLLA",
"state": "MO",
"postal_code": "654013061",
"telephone_number": "573-426-6712",
"fax_number": "573-426-6735"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SOUTH CENTRAL MISSOURI COMMUNITY HEALTH CENTER",
"organizational_subpart": "NO",
"enumeration_date": "2017-05-09",
"last_updated": "2017-05-09",
"status": "A",
"authorized_official_last_name": "MILLER",
"authorized_official_first_name": "KELLY",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "573-426-6712"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1164669172",
"state": "MO"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Your Community Health Center",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Rolla, MO
- John-Paul Soberano, MD
- Lauren Sommero, CPNP
- South Central Missouri Angels, LLC
- South Central Missouri Community Health Center
- South Central Missouri Community Health Center
- South Central Missouri Community Health Center
- South Central Missouri Community Health Center
- South Central Missouri Community Health Center
- South Central Missouri Community Health Center
- James J Spadaro Jr., M.D.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.