Active NPI
Perry County Health System
- Rural Health Clinic/Center
- Perryville, MO
National Provider Identifier
1467557488
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rural Health Clinic/Center
- Legal business name
- PERRY COUNTY HEALTH SYSTEM
- Practice address
- 212 Hospital LN
Suite 101
Perryville, MO 63775-1276 - Phone
- (573) 547-7888
- Fax
- (573) 547-5481
- NPI assigned
- Sep 14, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mrs. Stacey Reitzel
- Title
- Office Manager
- Phone
- (573) 547-7888
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Primary |
Addresses
Primary practice location
212 Hospital LN
Suite 101
Perryville, MO 63775-1276
Mailing address
212 Hospital LN
Suite 101
Perryville, MO 63775-1276
Phone (573) 547-7888
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 597917103 | Medicaid | MO | |
| 503318800 | Medicaid | MO |
Other names 1
- Perryville Family Care Clinic
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider DirectoryOwnership & related parties
Change-of-ownership history 1
| Date | Event | Counterparty |
|---|---|---|
| Oct 1, 2023 | Change of Ownership | Mercy Hospital Perry - RHC I |
Change of ownership 1
Medicare changes of ownership in which this facility was the buyer or the seller.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158192000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1318982400000",
"number": "1467557488",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "212 HOSPITAL LN",
"address_2": "SUITE 101",
"city": "PERRYVILLE",
"state": "MO",
"postal_code": "637751276",
"telephone_number": "573-547-7888",
"fax_number": "573-547-5481"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "212 HOSPITAL LN",
"address_2": "SUITE 101",
"city": "PERRYVILLE",
"state": "MO",
"postal_code": "637751276",
"telephone_number": "573-547-7888",
"fax_number": "573-547-5481"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PERRY COUNTY HEALTH SYSTEM",
"organizational_subpart": "NO",
"enumeration_date": "2006-09-14",
"last_updated": "2011-10-19",
"status": "A",
"authorized_official_last_name": "REITZEL",
"authorized_official_first_name": "STACEY",
"authorized_official_title_or_position": "OFFICE MANAGER",
"authorized_official_telephone_number": "573-547-7888",
"authorized_official_name_prefix": "Mrs."
},
"taxonomies": [
{
"code": "261QR1300X",
"taxonomy_group": "",
"desc": "Clinic/Center, Rural Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "597917103",
"state": "MO"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "503318800",
"state": "MO"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Perryville Family Care Clinic",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Perryville, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.