NPIMap

Organization Active NPI

Pemiscot County Memorial Hospital

Doing business as PMHS Convenient Care Clinic

  • Rural Health Clinic/Center
  • Hayti, MO
National Provider Identifier
1568574341
Registry record updated Oct 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
PEMISCOT COUNTY MEMORIAL HOSPITAL
Doing business as
PMHS Convenient Care Clinic
Practice address
946 E Reed St
Hayti, MO 63851-1243
Phone
(573) 359-6162
Fax
(573) 359-6165
NPI assigned
Aug 31, 2006
Last updated
Oct 13, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2026

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

Authorized official

Name
Brittany Nichole Osborne
Title
Chief Executive Officer
Phone
(573) 359-1372

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

946 E Reed St
Hayti, MO 63851-1243

Mailing address

946 E Reed St
P O Box 489
Hayti, MO 63851-1243
Phone (573) 359-6162

Other identifiers 1

IdentifierTypeStateIssuer
599256005MedicaidMO

Other names 1

  • PMHS Convenient Care Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040903001019 MO Part A Provider - Rural Health Clinic 8426024159 Practice locations: Hayti, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1568574341. Details of each certification follow.

Rural health clinic certification: CCN 268581

Legal name
PEMISCOT COUNTY MEMORIAL HOSPITAL
Doing business as
PMHS CONVENIENT CARE CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Apr 6, 2004
Last certification
Jan 24, 2023
Ownership / control type
Non-profit – church related
Organization structure
GovernmentNon-profit
Enrollment address
946 E Reed St
Hayti, MO 63851-1243
Related CCNs
260070

Other NPIs with the same Medicare PAC ID 7

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
26D1024303Convenient Care Clinic946 E Reed St, Hayti, MO 63851Certificate of waiverApr 6, 2028

National Provider Directory

National Provider Directory
Tax ID family
W O Bryant MD12 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.

Locations

946 E Reed St
Hayti, MO 63851
Phone (573) 359-3408

Ownership & related parties

All disclosed owners & managing parties 8

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Lance Crawford Individual Corporate DirectorBoard Member Jan 1, 2022
Lauren Turnage Individual W-2 Managing EmployeeRevenue Control Analyst Mar 1, 2023
Tara Martin Individual Corporate OfficerCoo Jan 1, 2023
Corporate DirectorCoo Jan 1, 2023
W-2 Managing EmployeeCoo Jan 1, 2023
Russell Gilmore Individual Corporate DirectorBoard Member Sep 6, 2013 20%
Timothy Gardner Individual Corporate DirectorBoard Member Sep 6, 2013 20%
Delila Swinger Individual Corporate DirectorBoard Member Sep 6, 2013 20%
Pemiscot County Memorial Hospital Organization, Hayti, MO 5% Or Greater Direct Ownership Interest Oct 1, 2003 100%
Operational/Managerial Control Oct 1, 2003 100%
Stephen Reid Individual Corporate DirectorBoard Member Sep 6, 2013 20%

Owners & managing parties with NPI records 7

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 5

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Pemiscot County Memorial HospitalHayti, MO, CCN 260780 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1997
Doctors ClinicCaruthersville, MO, CCN 268537 Rural health clinic Operational/Managerial Control Jan 29, 2002
Pemiscot Primary Care CenterHayti, MO, CCN 263434 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Sep 7, 1994
Sep 7, 1994
Bootheel Primary Care - CaruthersvilleCaruthersville, MO, CCN 268626 Rural health clinic Operational/Managerial Control Apr 1, 2008
Bootheel Primary Care Clinic SteeleSteele, MO, CCN 268628 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jul 1, 2008
Jul 1, 2008

Owned or controlled facilities with NPI records 5

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 5

Facilities that share an organizational owner with 5% or greater ownership or operational control.

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.

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1791849600000",
    "number": "1568574341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "946 E REED ST",
            "address_2": "P O BOX 489",
            "city": "HAYTI",
            "state": "MO",
            "postal_code": "638511243",
            "telephone_number": "573-359-6162",
            "fax_number": "573-359-6165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "946 E REED ST",
            "city": "HAYTI",
            "state": "MO",
            "postal_code": "638511243",
            "telephone_number": "573-359-6162",
            "fax_number": "573-359-6165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEMISCOT COUNTY MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2026-10-13",
        "certification_date": "2026-10-13",
        "status": "A",
        "authorized_official_last_name": "OSBORNE",
        "authorized_official_first_name": "BRITTANY",
        "authorized_official_middle_name": "NICHOLE",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "573-359-1372"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "599256005",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PMHS Convenient Care Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PMHS Convenient Care Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hayti, MO

Sources for this page

Verify at the official NPI Registry.