NPIMap

Organization Active NPI

McCoy Samples Mattingly Dental Clinic

  • General Practice Dentistry
  • Chillicothe, MO
National Provider Identifier
1457551483
Registry record updated Feb 18, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
MCCOY SAMPLES MATTINGLY DENTAL CLINIC
Practice address
850 Fairway Dr
Chillicothe, MO 64601
Phone
(660) 646-3802
Fax
(660) 646-3887
NPI assigned
Jul 18, 2007
Last updated
Feb 18, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 18, 2019

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

Authorized official

Name
Dr. Rolfe C McCoy, DMDNPI 1811088016
Title
Ceo
Phone
(660) 646-3802

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

850 Fairway Dr
Chillicothe, MO 64601

Mailing address

850 Fairway Dr
PO Box 1167
Chillicothe, MO 64601

Other names 1

  • McCoy Dental Clinic Former legal business name

National Provider Directory

National Provider Directory

Locations

850 Fairway Dr
Chillicothe, MO 64601
Phone (660) 646-3802

Practitioners & affiliated clinicians

Practitioners 1

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": "1184716800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1550448000000",
    "number": "1457551483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "850 FAIRWAY DR",
            "address_2": "PO BOX 1167",
            "city": "CHILLICOTHE",
            "state": "MO",
            "postal_code": "64601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "850 FAIRWAY DR",
            "city": "CHILLICOTHE",
            "state": "MO",
            "postal_code": "64601",
            "telephone_number": "660-646-3802",
            "fax_number": "660-646-3887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCCOY SAMPLES MATTINGLY DENTAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-18",
        "last_updated": "2019-02-18",
        "status": "A",
        "authorized_official_last_name": "MCCOY",
        "authorized_official_first_name": "ROLFE",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "660-646-3802",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "McCoy Dental Clinic",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Chillicothe, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.