NPIMap

Organization Active NPI

East Central Missouri Behavioral Health Services, Inc

  • Federally Qualified Health Center (FQHC)
  • Montgomery City, MO
National Provider Identifier
1376164699
Registry record updated Dec 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
EAST CENTRAL MISSOURI BEHAVIORAL HEALTH SERVICES, INC
Practice address
1225 Aguilar Dr.
Montgomery City, MO 63361
Phone
(573) 582-1234
Fax
(573) 582-1212
NPI assigned
Apr 27, 2020
Last updated
Dec 12, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2024

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

Authorized official

Name
Jeanann Early
Title
Director of Compliance
Phone
(573) 582-1234

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

1225 Aguilar Dr.
Montgomery City, MO 63361

Mailing address

340 Kelley Pkwy
Mexico, MO 65265-3811
Phone (573) 581-1196

Other identifiers 1

IdentifierTypeStateIssuer
500100410MedicaidMO

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210809000811 MO Part A Provider - Federally Qualified Health Center (FQHC) 5395659403 Practice locations: Montgomery City, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1376164699. Details of each certification follow.

Federally qualified health center certification: CCN 791143

Legal name
EAST CENTRAL MISSOURI BEHAVIORAL HEALTH SERVICES, INC.
Doing business as
ARTHUR CENTER BEHAVIORAL HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 4, 2021
Last certification
Aug 4, 2021
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
1225 Aguilar Dr
Montgomery City, MO 63361-2723

Other NPIs with the same Medicare PAC ID 3

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

National Provider Directory

National Provider Directory
Tax ID family
East Central Mo Srvcs Inc15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

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

View all 14

Locations

400 E Liberty St
Mexico, MO 65265
Phone (573) 581-7887

896 S Sturgeon St
Montgomery City, MO 63361

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Melissa Deimeke Individual Corporate Director Oct 1, 2024
Timothy Michael Crews Individual Corporate DirectorBoard Member Jun 1, 2021
Travis Fleming Individual W-2 Managing EmployeeChief Compliance Officer Oct 17, 2022
Jeanann Early Individual Corporate DirectorDirector of Human Resources Jan 13, 2025
Humza Waheed Individual W-2 Managing EmployeeMD; Sep 24, 2015
Kelsey Kreyling Individual Corporate DirectorVice President Jun 1, 2021
Lan-Tu Dang Holem Individual Corporate OfficerDental Director Jun 1, 2021
Warren Norwald Individual Corporate DirectorBoard Member Jun 1, 2021
Cheri Erdel Individual Corporate DirectorBoard Member Jun 1, 2021
Lauren Oliver Individual Corporate DirectorSecretary/Treasurer Nov 1, 2022
Steve Kreyling Individual Corporate DirectorPresident Jun 1, 2021
Ahmed a Taranissi Individual W-2 Managing EmployeeMD; Jun 1, 2021
Donald Brock Lough Individual Corporate OfficerChief Executive Officer Jul 15, 2024

Owners & managing parties with NPI records 3

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Arthur Center Community HealthMexico, MO, CCN 261071 Federally qualified health center Operational/Managerial Control (100%) Jan 1, 2003

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 50

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.

View all 50

NPI Registry JSON

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

{
    "created_epoch": "1587945600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733961600000",
    "number": "1376164699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "340 KELLEY PKWY",
            "city": "MEXICO",
            "state": "MO",
            "postal_code": "652653811",
            "telephone_number": "573-581-1196",
            "fax_number": "573-581-1981"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1225 AGUILAR DR.",
            "city": "MONTGOMERY CITY",
            "state": "MO",
            "postal_code": "63361",
            "telephone_number": "573-582-1234",
            "fax_number": "573-582-1212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST CENTRAL MISSOURI BEHAVIORAL HEALTH SERVICES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-27",
        "last_updated": "2024-12-12",
        "certification_date": "2024-12-12",
        "status": "A",
        "authorized_official_last_name": "EARLY",
        "authorized_official_first_name": "JEANANN",
        "authorized_official_title_or_position": "DIRECTOR OF COMPLIANCE",
        "authorized_official_telephone_number": "573-582-1234"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500100410",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Montgomery City, MO

Sources for this page

Verify at the official NPI Registry.