NPIMap

Organization Active NPI

Ste Genevieve County Memorial Hospital

  • Medical Specialty Clinic/Center
  • Ste Genevieve, MO
National Provider Identifier
1295030807
Registry record updated Jan 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Specialty Clinic/CenterTaxonomy code 261QM2500X
Legal business name
STE GENEVIEVE COUNTY MEMORIAL HOSPITAL
Practice address
120 Plaza Dr
Ste Genevieve, MO 63670-1828
Phone
(573) 883-2782
Fax
(573) 883-3684
NPI assigned
Jan 13, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2023

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

Authorized official

Name
Amanda Wolk
Title
Business Office Director
Phone
(573) 883-7703

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Specialty Clinic/Center 261QM2500X Primary

Addresses

Primary practice location

120 Plaza Dr
Ste Genevieve, MO 63670-1828

Mailing address

120 Plaza Dr
Ste Genevieve, MO 63670-1828
Phone (573) 883-5717

Other identifiers 2

IdentifierTypeStateIssuer
504887308MedicaidMO
CC8331OtherMORAILROAD MEDICARE

Other names 1

  • Me'Tis Breast Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040204000815 MO Part B Supplier - Clinic/Group Practice 3274432802 Receives reassigned benefits from 53 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Ste Genevieve, MO; Perryville, MO; Fredericktown, MO

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory
Tax ID family
Ste Genevieve Co Hospital17 organizations share this tax ID, including this one

Other organizations with this tax ID 16

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

View all 16

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1294876800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673568000000",
    "number": "1295030807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 PLAZA DR",
            "city": "STE GENEVIEVE",
            "state": "MO",
            "postal_code": "636701828",
            "telephone_number": "573-883-5717",
            "fax_number": "573-883-3684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 PLAZA DR",
            "city": "STE GENEVIEVE",
            "state": "MO",
            "postal_code": "636701828",
            "telephone_number": "573-883-2782",
            "fax_number": "573-883-3684"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STE GENEVIEVE COUNTY MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-13",
        "last_updated": "2023-01-13",
        "certification_date": "2023-01-13",
        "status": "A",
        "authorized_official_last_name": "WOLK",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "BUSINESS OFFICE DIRECTOR",
        "authorized_official_telephone_number": "573-883-7703"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "504887308",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CC8331",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Me'Tis Breast Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Me'Tis Breast Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ste Genevieve, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2023; 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.