Scotland County Memorial Hospital
Organization Active NPI Rural Health Clinic/Center · Wyaconda, MO
NPI 1528077534 · NPPES record last updated Jun 20, 2025
Key facts
- NPI
- 1528077534
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- SCOTLAND COUNTY MEMORIAL HOSPITAL
- Practice address
- 11024 Jefferson St
Wyaconda, MO 63474-2236 - Phone
- (660) 479-5553
- Fax
- (660) 479-5520
- NPI assigned
- Aug 7, 2006
- Organization subpart
- No
Authorized official
- Name
- Meagan E Weber
- Title
- Ceo
- Phone
- (660) 465-8511
Owners & managing parties with NPI records 5
Owned or controlled facilities with NPI records 5
Other NPIs with the same Medicare PAC ID 5
Corporate family (same tax ID) 13
Related certifications (CCN) 1
Facilities with the same owner 5
Practitioners 33
-
Kelsey M Davis-Humes, D.O
-
Lori A Claypool, DO
-
Jeffrey D Davis, DO
-
Deborah A.K Holte, DPM
-
Stanley Raymond Horner, D.O.
-
Neil E Hoyal, M.D., D.O.
-
Robert Wayne Jackson, D.O.
-
Iqbal Akhtar Yar Khan, M.D.
-
Jay Nastav, DO
-
Aaron Neisen, D.O.
-
Tabitha Sarah Rohr, NP-C
-
Robert P Schneider, D.O.
-
Brandi Ann White, FNP
-
William H Dixon, M.D
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 26D0936594 | Wyaconda Medical Services | Certificate of waiver | Nov 24, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
Rural health clinic certification: CCN 268519
- Legal name
- SCOTLAND COUNTY MEMORIAL HOSPITAL
- Doing business as
- WYACONDA MEDICAL SERVICES
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Dec 11, 1997
- Last certification
- Sep 13, 2023
- Ownership / control type
- Non-profit – church related
- Organization structure
- Other · Non-profit
- Enrollment address
- 11024 Jefferson St
Wyaconda, MO 63474-2236 - Related CCNs
- 261310
All disclosed owners & managing parties 9
| Name | Role | Since | Share |
|---|---|---|---|
| Meagan Weber |
Corporate Officer |
Aug 16, 2022 | 100% |
| W-2 Managing Employee |
Aug 16, 2022 | 100% | |
| Operational/Managerial Control |
Aug 16, 2022 | 100% | |
| Lori Fulk |
Corporate Director |
Apr 28, 2016 | |
| Aarron Holt |
Corporate Officer |
Sep 27, 2022 | |
| Christine Musgrove |
Corporate Officer |
Oct 10, 2022 | |
| Nicholas Hatfield |
Corporate Director |
Apr 28, 2020 | |
| Travis Trueblood |
Corporate Officer |
Jan 25, 2022 | |
| Brent M Peirick |
Corporate Officer |
Aug 16, 2022 | |
| W-2 Managing Employee | Aug 16, 2022 | 100% | |
| Operational/Managerial Control |
Aug 16, 2022 | 100% | |
| Scotland County Memorial Hospital |
Operational/Managerial Control | Dec 11, 1997 | 100% |
| Jesse Zeist |
Corporate Officer |
Oct 10, 2022 |
All facility ownership & control disclosures 5
| Facility | Type | Role | Since |
|---|---|---|---|
| Scotland County Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | May 1, 2008 |
| Scotland County Hospital |
Hospital | 5% Or Greater Direct Ownership Interest | May 1, 2008 |
| Lancaster Medical Services |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Jan 8, 2001 |
| Memphis Medical Services |
Rural health clinic | Operational/Managerial Control (100%) | Jul 1, 1999 |
| Edina Medical Services |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Feb 10, 2020 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080611000137 | MO | Part a Provider - Rural Health Clinic | 8224940366 | Practice locations: Wyaconda, MO |
National Provider Directory
- Tax ID family
- Scotland County Memorial Hospital Dba Kahoka Medical Services
Locations
11024 Jefferson St
Wyaconda, MO 63474
Phone (660) 479-5553
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | |||
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
11024 Jefferson St
Wyaconda, MO 63474-2236
Mailing address
11024 Jefferson St
Wyaconda, MO 63474-2236
Phone (660) 479-5553
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 599764305 | Medicaid | MO |
Other names
- WYACONDA MEDICAL SERVICES
Other providers in Wyaconda, MO
All providers in Wyaconda, MO · Rural Health Clinic/Center in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 20, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.