Active NPI
SSM Audrain Health Care, Inc.
- Rural Health Clinic/Center
- Mexico, MO
National Provider Identifier
1467462010
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rural Health Clinic/Center
- Legal business name
- SSM AUDRAIN HEALTH CARE, INC.
- Doing business as
- SSM Health Medical Group - Family Medicine
- Practice address
- 626 E Summit St Ste L
Mexico, MO 65265-3298 - Phone
- (573) 581-6266
- Fax
- (573) 581-0955
- NPI assigned
- Aug 8, 2006
- Organization subpart
- Yes
- Parent organization
- SSM AUDRAIN HEALTH CARE. INC.
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Robert V. Vanconia
- Title
- President/Ceo
- Phone
- (573) 582-8108
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | |||
| Rural Health Clinic/Center | 261QR1300X | Primary |
Addresses
Primary practice location
626 E Summit St Ste L
Mexico, MO 65265-3298
Mailing address
626 E Summit St Ste L
Mexico, MO 65265-3298
Phone (573) 581-6266
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 597765809 | Medicaid | MO | |
| 507765808 | Medicaid | MO |
Other names 1
- SSM Health Medical Group - Family Medicine
National Provider Directory
National Provider Directory- Part of
- Rusty Spieler MD
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154995200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1431043200000",
"number": "1467462010",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "626 E SUMMIT ST STE L",
"city": "MEXICO",
"state": "MO",
"postal_code": "652653298",
"telephone_number": "573-581-6266",
"fax_number": "573-581-0955"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "626 E SUMMIT ST STE L",
"city": "MEXICO",
"state": "MO",
"postal_code": "652653298",
"telephone_number": "573-581-6266",
"fax_number": "573-581-0955"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SSM AUDRAIN HEALTH CARE, INC.",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "SSM AUDRAIN HEALTH CARE. INC.",
"enumeration_date": "2006-08-08",
"last_updated": "2015-05-08",
"status": "A",
"authorized_official_last_name": "VANCONIA",
"authorized_official_first_name": "ROBERT",
"authorized_official_middle_name": "V.",
"authorized_official_title_or_position": "PRESIDENT/CEO",
"authorized_official_telephone_number": "573-582-8108",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": false
},
{
"code": "261QR1300X",
"taxonomy_group": "",
"desc": "Clinic/Center, Rural Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "597765809",
"state": "MO"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "507765808",
"state": "MO"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "SSM Health Medical Group - Family Medicine",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Mexico, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.