Country Care Medical Clinic and Pharmacy, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

102015 Issued in MO

Legal business name

COUNTRY CARE MEDICAL CLINIC AND PHARMACY, LLC

Practice address

1504 N Business 71
Neosho, MO 64850-1975

Phone

(417) 455-2883

Fax

(417) 455-9358

NPI assigned

Feb 6, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Dennis Murl Gallemore, M.S.

Title

Clinic Manager

Phone

(417) 455-2883

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1170720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1508906165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1504 N BUSINESS 71",
            "city": "NEOSHO",
            "state": "MO",
            "postal_code": "648501975",
            "telephone_number": "417-455-2883",
            "fax_number": "417-455-9358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1504 N BUSINESS 71",
            "city": "NEOSHO",
            "state": "MO",
            "postal_code": "648501975",
            "telephone_number": "417-455-2883",
            "fax_number": "417-455-9358"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRY CARE MEDICAL CLINIC AND PHARMACY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GALLEMORE",
        "authorized_official_first_name": "DENNIS",
        "authorized_official_middle_name": "MURL",
        "authorized_official_title_or_position": "CLINIC MANAGER",
        "authorized_official_telephone_number": "417-455-2883",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.S."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "102015",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.