NPIMap

Organization Active NPI

Texas County Memorial Hospital

Doing business as TCMH - Mountain Grove Clinic

  • Rural Health Clinic/Center
  • Mountain Grove, MO
National Provider Identifier
1265754501
Registry record updated Oct 31, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
TEXAS COUNTY MEMORIAL HOSPITAL
Doing business as
TCMH - Mountain Grove Clinic
Practice address
1905 West 19TH Street
Mountain Grove, MO 65711
Phone
(417) 926-1770
Fax
(417) 926-1785
NPI assigned
Feb 26, 2010
Last updated
Oct 31, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
TEXAS COUNTY MEMORIAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 31, 2016

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

Authorized official

Name
Mrs. Linda J. Pamperien
Title
Chief Financial Officer
Phone
(417) 967-3311

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

1905 West 19TH Street
Mountain Grove, MO 65711

Mailing address

1905 West 19TH Street
Mountain Grove, MO 65711
Phone (417) 926-1770

Other identifiers 3

IdentifierTypeStateIssuer
26D2006074OtherMOCLIA
1265754501MedicaidMO
1285957001MedicaidMO

Other names 1

  • TCMH - Mountain Grove Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100505000258 MO Part A Provider - Rural Health Clinic 9436041696 Practice locations: Mountain Grove, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1265754501. Details of each certification follow.

Rural health clinic certification: CCN 268653

Legal name
TEXAS COUNTY MEMORIAL HOSPITAL
Doing business as
TCMH MOUNTAIN GROVE CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 1, 2010
Last certification
Mar 13, 2024
Ownership / control type
Non-profit – church related
Organization structure
GovernmentNon-profit
Enrollment address
1905 W 19TH St
Mountain Grove, MO 65711-1287
Related CCNs
260024

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 14

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

View all 14

National Provider Directory

National Provider Directory
Tax ID family
Texas County Memorial HSP16 organizations share this tax ID, including this one
Part of
Texas County Memorial HSP

Other organizations with this tax ID 15

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

View all 15

Ownership & related parties

All disclosed owners & managing parties 9

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Ross Richardson Individual Corporate DirectorBoard Member Apr 4, 2023
Linda J Pamperien Individual Corporate OfficerCfo Nov 4, 1996
Corporate DirectorCfo Nov 4, 1996
W-2 Managing EmployeeCfo Feb 12, 2014
Allan Branstetter Individual Corporate DirectorBoard Member Apr 2, 2019
Joleen Durham Individual Corporate DirectorBoard Member Apr 6, 2021
Stacy D Holland Individual Corporate OfficerCeo Nov 14, 2022 100%
Corporate DirectorCeo Nov 14, 2022 100%
W-2 Managing EmployeeCeo May 9, 2023 100%
Steve Pierce Individual Corporate DirectorBoard Member Jun 2, 2020
William Bridges Individual Corporate OfficerLeadership Team Ao Jul 14, 2022
W-2 Managing EmployeeLeadership Team Ao Jul 14, 2022
James R Perry Individual Corporate DirectorBoard Member Jan 27, 2012
Texas County Memorial Hospital Organization, Houston, MO 5% Or Greater Direct Ownership Interest Apr 19, 2010 100%
Operational/Managerial Control Feb 12, 2014 100%

Owners & managing parties with NPI records 14

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

View all 14

All facility ownership & control disclosures 7

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

FacilityTypeRoleSince
Texas County Memorial HospitalHouston, MO, CCN 260024 Hospital 5% Or Greater Direct Ownership Interest (100%) Dec 1, 1983
Texas County Memorial Hospital Swing BedHouston, MO, CCN 26U024 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 8, 2015
Home Health of the OzarksHouston, MO, CCN 267185 Home health agency 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Mar 8, 1984
Mar 8, 1984
Hospice of CareHouston, MO, CCN 261501 Hospice 5% Or Greater Direct Ownership Interest (100%) Dec 1, 1983
TCMH Cabool Medical ClinicCabool, MO, CCN 268603 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Sep 7, 2005
Sep 7, 2005
TCMH Family Clinic - LickingLicking, MO, CCN 268630 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Nov 1, 1991
TCMH Internal MedicineHouston, MO, CCN 268535 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Nov 14, 2001
Nov 14, 2001

Owned or controlled facilities with NPI records 7

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

Facilities with the same owner 7

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1267142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1477872000000",
    "number": "1265754501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1905 WEST 19TH STREET",
            "city": "MOUNTAIN GROVE",
            "state": "MO",
            "postal_code": "65711",
            "telephone_number": "417-926-1770",
            "fax_number": "417-926-1785"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1905 WEST 19TH STREET",
            "city": "MOUNTAIN GROVE",
            "state": "MO",
            "postal_code": "65711",
            "telephone_number": "417-926-1770",
            "fax_number": "417-926-1785"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TEXAS COUNTY MEMORIAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TEXAS COUNTY MEMORIAL HOSPITAL",
        "enumeration_date": "2010-02-26",
        "last_updated": "2016-10-31",
        "status": "A",
        "authorized_official_last_name": "PAMPERIEN",
        "authorized_official_first_name": "LINDA",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "417-967-3311",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "26D2006074",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1265754501",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1285957001",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TCMH - Mountain Grove Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mountain Grove, MO

Sources for this page

Verify at the official NPI Registry.