Active NPI
Caruthersville Clinic
- Family Medicine Physician
- Caruthersville, MO
National Provider Identifier
1487829222
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- CARUTHERSVILLE CLINIC
- Practice address
- 412 Ward Ave
Caruthersville, MO 63830-1451 - Phone
- (579) 333-0033
- Fax
- (573) 333-2522
- NPI assigned
- Apr 23, 2008
- Last updated
- Apr 23, 2008
- 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. Amy D Ledbetter
- Title
- Director of Operations
- Phone
- (573) 651-4488
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | NU | Primary |
Addresses
Primary practice location
412 Ward Ave
Caruthersville, MO 63830-1451
Mailing address
PO Box 881
Caruthersville, MO 63830-0881
Phone (579) 333-0033
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 507402907 | Medicaid | MO |
National Provider Directory
National Provider Directory- Tax ID family
- Caruthersville Clinic
Other organizations with this tax ID 2
Organizations that report the same tax identification number in the National Provider Directory.
-
- Rural Health Clinic/Center
- Hayti, MO
- NPI 1497929335
-
- Family Medicine Physician
- Caruthersville, MO
- NPI 1467442566
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.
-
- Pediatrics Physician
- Portageville, MO
- NPI 1619967106
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1208908800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1208908800000",
"number": "1487829222",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 881",
"city": "CARUTHERSVILLE",
"state": "MO",
"postal_code": "638300881",
"telephone_number": "579-333-0033",
"fax_number": "573-333-2522"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "412 WARD AVE",
"city": "CARUTHERSVILLE",
"state": "MO",
"postal_code": "638301451",
"telephone_number": "579-333-0033",
"fax_number": "573-333-2522"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CARUTHERSVILLE CLINIC",
"organizational_subpart": "NO",
"enumeration_date": "2008-04-23",
"last_updated": "2008-04-23",
"status": "A",
"authorized_official_last_name": "LEDBETTER",
"authorized_official_first_name": "AMY",
"authorized_official_middle_name": "D",
"authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
"authorized_official_telephone_number": "573-651-4488",
"authorized_official_name_prefix": "Mrs."
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "507402907",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Caruthersville, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.