NPIMap

Organization Active NPI

Perry County Health System

Doing business as Perry County Physician Services

  • Rural Health Clinic/Center
  • Perryville, MO
National Provider Identifier
1619921160
Registry record updated Dec 30, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
PERRY COUNTY HEALTH SYSTEM
Doing business as
Perry County Physician Services
Practice address
206 Hospital LN
Perryville, MO 63775-1276
Phone
(573) 547-4899
Fax
(573) 547-5388
NPI assigned
May 20, 2006
Last updated
Dec 30, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2014

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

Authorized official

Name
Mr. Patrick Carron
Title
President/Ceo
Phone
(573) 547-2536

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X
Sports Medicine (Orthopaedic Surgery) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207XX0005X
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X
Clinic/Center 261Q00000X
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

206 Hospital LN
Perryville, MO 63775-1276

Mailing address

206 Hospital Lane
Perryville, MO 63775-1382
Phone (573) 547-4899

Other identifiers 1

IdentifierTypeStateIssuer
505251108MedicaidMO

Other names 1

  • PERRY COUNTY PHYSICIAN SERVICES Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

206 Hospital Ln
Perryville, MO 63775
Phone (573) 547-4899

Ownership & related parties

Change-of-ownership history 1

DateEventCounterparty
Oct 1, 2023 Change of OwnershipThis provider was the seller Mercy Hospital Perry - RHC IICCN 268614, MO, NPI 1215613880

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

NPI Registry JSON

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

{
    "created_epoch": "1148083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1419897600000",
    "number": "1619921160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "206 HOSPITAL LANE",
            "city": "PERRYVILLE",
            "state": "MO",
            "postal_code": "637751382",
            "telephone_number": "573-547-4899",
            "fax_number": "573-547-5388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "206 HOSPITAL LN",
            "city": "PERRYVILLE",
            "state": "MO",
            "postal_code": "637751276",
            "telephone_number": "573-547-4899",
            "fax_number": "573-547-5388"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERRY COUNTY HEALTH SYSTEM",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-20",
        "last_updated": "2014-12-30",
        "status": "A",
        "authorized_official_last_name": "CARRON",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "573-547-2536",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207XX0005X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "505251108",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PERRY COUNTY PHYSICIAN SERVICES",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Perryville, MO

Sources for this page

Verify at the official NPI Registry.