Professional Clinics, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

PROFESSIONAL CLINICS, LLC

Practice address

624 Old Saint Marys Rd
Suite a
Perryville, MO 63775-1837

Phone

(573) 547-3232

Fax

(573) 547-3231

NPI assigned

May 10, 2016

Organization subpart

No

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

Authorized official

Name

Mrs. Amelia D Ledbetter

Title

Director of Operations

Phone

(573) 335-4715

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Convenient Healthcare Doing business as

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

{
    "created_epoch": "1462838400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1462838400000",
    "number": "1477909372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "624 OLD SAINT MARYS RD",
            "address_2": "SUITE A",
            "city": "PERRYVILLE",
            "state": "MO",
            "postal_code": "637751837",
            "telephone_number": "573-547-3232",
            "fax_number": "573-547-3231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "624 OLD SAINT MARYS RD",
            "address_2": "SUITE A",
            "city": "PERRYVILLE",
            "state": "MO",
            "postal_code": "637751837",
            "telephone_number": "573-547-3232",
            "fax_number": "573-547-3231"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL CLINICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-10",
        "last_updated": "2016-05-10",
        "status": "A",
        "authorized_official_last_name": "LEDBETTER",
        "authorized_official_first_name": "AMELIA",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "573-335-4715",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PART B",
            "identifier": "MA1758",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Convenient Healthcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Perryville Health Center LLC
• Perryville Healthcare Corporation
• Perryville Orthodontics LLC
• Granville J Phillips, M.D.
• Professional Clinics LLC
• Prorehab PC
• Jackson Charles Pugh, M.D.
• Sandeep C. Rao, M.D.
• Adam Joseph Reinagel, MD
• Bethany Joy Rhodes, SLP

• All providers in Perryville, MO
• Family Medicine Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2016; 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.