NPIMap

Organization Active NPI

Texas County Memorial Hospital

Doing business as TCMH Family Clinic - Licking

  • Rural Health Clinic/Center
  • Licking, MO
National Provider Identifier
1447412770
Registry record updated Jul 12, 2024
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 Family Clinic - Licking
Practice address
139 W Highway 32
Licking, MO 65542-9898
Phone
(573) 674-3011
Fax
(573) 674-4765
NPI assigned
Jun 27, 2008
Last updated
Jul 12, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
TEXAS COUNTY MEMORIAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 12, 2024

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

Authorized official

Name
Mrs. Linda J Pamperien
Title
Cfo
Phone
(417) 967-3311

Specialties & licenses 1

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

Addresses

Primary practice location

139 W Highway 32
Licking, MO 65542-9898

Mailing address

139 W Highway 32
Licking, MO 65542-9898
Phone (573) 674-3011

Other identifiers 2

IdentifierTypeStateIssuer
1447412770OtherMORH - MEDICAID
26D0679044OtherMOCLIA

Other names 1

  • TCMH FAMILY CLINIC - LICKING Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080826000242 MO Part A Provider - Rural Health Clinic 9436041696 Practice locations: Licking, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1447412770. Details of each certification follow.

Rural health clinic certification: CCN 268630

Legal name
TEXAS COUNTY MEMORIAL HOSPITAL
Doing business as
TCMH FAMILY CLINIC - LICKING
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 21, 2009
Last certification
Sep 21, 2022
Ownership / control type
Non-profit – church related
Organization structure
GovernmentNon-profit
Enrollment address
139 W Highway 32
Licking, MO 65542-9898
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
TCMH Medical Ctr16 organizations share this tax ID, including this one
Part of
TCMH Medical Ctr

Other organizations with this tax ID 15

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

View all 15

Locations

233 S Main St
Licking, MO 65542
Phone (573) 674-3011

Ownership & related parties

All disclosed owners & managing parties 7

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
W-2 Managing EmployeeCfo Nov 4, 1996
Jennifer Hugenot Individual Corporate DirectorBoard Member Apr 2, 2024
Joleen Durham Individual Corporate DirectorBoard Member Apr 6, 2021
William Bridges Individual Corporate OfficerBoard Approved Signer Jul 14, 2022
W-2 Managing EmployeeBoard Approved Signer 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 Nov 1, 1991 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 Mountain Grove ClinicMountain Grove, MO, CCN 268653 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Apr 19, 2010
Feb 12, 2014
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 10

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": "1214524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720742400000",
    "number": "1447412770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "139 W HIGHWAY 32",
            "city": "LICKING",
            "state": "MO",
            "postal_code": "655429898",
            "telephone_number": "573-674-3011",
            "fax_number": "573-674-4765"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "139 W HIGHWAY 32",
            "city": "LICKING",
            "state": "MO",
            "postal_code": "655429898",
            "telephone_number": "573-674-3011",
            "fax_number": "573-674-4765"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TEXAS COUNTY MEMORIAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TEXAS COUNTY MEMORIAL HOSPITAL",
        "enumeration_date": "2008-06-27",
        "last_updated": "2024-07-12",
        "certification_date": "2024-07-12",
        "status": "A",
        "authorized_official_last_name": "PAMPERIEN",
        "authorized_official_first_name": "LINDA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "417-967-3311",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RH - MEDICAID",
            "identifier": "1447412770",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "26D0679044",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TCMH FAMILY CLINIC - LICKING",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Licking, MO

Sources for this page

Verify at the official NPI Registry.