NPIMap

Organization Active NPI

Pemiscot County Memorial Hospital

  • Family Medicine Physician
  • Kennett, MO
National Provider Identifier
1477091890
Registry record updated Feb 6, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PEMISCOT COUNTY MEMORIAL HOSPITAL
Practice address
105 E Washington St
Kennett, MO 63857-2041
Phone
(573) 888-1137
Fax
(573) 888-0920
NPI assigned
Feb 6, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 6, 2017

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

Authorized official

Name
Kerry Noble
Title
Ceo
Phone
(573) 359-3612

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

105 E Washington St
Kennett, MO 63857-2041

Mailing address

105 E. Washington
Kennett, MO 63857
Phone (573) 888-1137

Other names 1

  • Bootheel Family Practice Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Penniscot County Mem Ho12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

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

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1486339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1486339200000",
    "number": "1477091890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 E. WASHINGTON",
            "city": "KENNETT",
            "state": "MO",
            "postal_code": "63857",
            "telephone_number": "573-888-1137",
            "fax_number": "573-888-0920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 E WASHINGTON ST",
            "city": "KENNETT",
            "state": "MO",
            "postal_code": "638572041",
            "telephone_number": "573-888-1137",
            "fax_number": "573-888-0920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEMISCOT COUNTY MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-06",
        "last_updated": "2017-02-06",
        "status": "A",
        "authorized_official_last_name": "NOBLE",
        "authorized_official_first_name": "KERRY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "573-359-3612"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bootheel Family Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kennett, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2017; 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.