NPIMap

Organization Active NPI

Northeast Missouri Health Council, Inc.

Doing business as Kirksville Veterans Clinic

  • Family Medicine Physician
  • Kirksville, MO
National Provider Identifier
1609059815
Registry record updated Jan 24, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
R5C53 Issued in MO
Legal business name
NORTHEAST MISSOURI HEALTH COUNCIL, INC.
Doing business as
Kirksville Veterans Clinic
Practice address
1510 Crown Drive
Kirksville, MO 63501-4002
Phone
(660) 627-8387
Fax
(660) 627-0878
NPI assigned
Dec 11, 2007
Last updated
Jan 24, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2011

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

Authorized official

Name
Andrew H Grimm
Title
Executive Director
Phone
(660) 627-5757

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 104748 MO
Family Nurse Practitioner 363LF0000X 2010018560 MO
Professional Counselor 101YP2500X 2203032101 MO
Family Medicine Physician 207Q00000X R5C53 MO Primary

Addresses

Primary practice location

1510 Crown Drive
Kirksville, MO 63501-4002

Mailing address

1416 Crown Drive
Kirksville, MO 63501-0000
Phone (660) 627-5757

Other names 1

  • Kirksville Veterans Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Northeast Missouri Fami13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1510 Crown Dr
Kirksville, MO 63501
Phone (660) 627-3621

Practitioners & affiliated clinicians

Practitioners 4

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": "1197331200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1295827200000",
    "number": "1609059815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1416 CROWN DRIVE",
            "city": "KIRKSVILLE",
            "state": "MO",
            "postal_code": "635010000",
            "telephone_number": "660-627-5757",
            "fax_number": "660-627-5802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1510 CROWN DRIVE",
            "city": "KIRKSVILLE",
            "state": "MO",
            "postal_code": "635014002",
            "telephone_number": "660-627-8387",
            "fax_number": "660-627-0878"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST MISSOURI HEALTH COUNCIL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-11",
        "last_updated": "2011-01-24",
        "status": "A",
        "authorized_official_last_name": "GRIMM",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "660-627-5757"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MO",
            "license": "104748",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "2010018560",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MO",
            "license": "2203032101",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "R5C53",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kirksville Veterans Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kirksville, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2011; 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.