Regional Health Care Clinic, Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Warsaw, MO
NPI 1629797196 · NPPES record last updated Feb 21, 2024
Key facts
- NPI
- 1629797196
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- REGIONAL HEALTH CARE CLINIC, INC
- Practice address
- 20363 Lane of Champions
Warsaw, MO 65355-6463 - Phone
- (660) 438-7120
- Fax
- (888) 979-8868
- NPI assigned
- Aug 26, 2022
- Organization subpart
- No
Authorized official
- Name
- Michael Waller
- Title
- Ceo
- Phone
- (660) 438-7120
Other NPIs with the same Medicare PAC ID 6
Corporate family (same tax ID) 17
Practitioners 59
-
Molly Boston, LCSW
-
Cori Lynne Bradshaw, APRN
-
Jenie Bruce, NP
-
Lynda G Carlyle, FNP
-
Jeffrey S Carver, FNP
-
Brianna Cordova, LCSW
-
Justin Robert Cramer, M.D.
-
Mary J Drenon, FNP
-
Kayla Jean Evans, FNP
-
Bhavini Gopaldas, PA
-
Chauncey B Haley, O.D.
-
Madison Hohne, FNP
-
Yasmin Dara Jilla, M.D.
-
Teri C Lada, LPC
-
Sylvia Lawson-Cook, LCSW
-
Alecia Kimberly Liburd, PMHNP
-
Stephanie R Nicholson, FNP-C
-
Angela Dawn Pike, DNP, FNP-C, PMHNP-BC
-
Megan Rowland, NP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
Federally qualified health center certification: CCN 261917
- Legal name
- REGIONAL HEALTH CARE CLINIC INC
- Doing business as
- KATY TRAIL COMMUNITY HEALTH
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Nov 17, 2022
- Last certification
- Nov 17, 2022
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Nov 3, 1999 in MO
- Enrollment address
- 20363 Lane of Champions
Warsaw, MO 65355-6463
All disclosed owners & managing parties 4
| Name | Role | Since | Share |
|---|---|---|---|
| Angela Saran |
Corporate Officer |
Mar 1, 2008 | |
| Corporate Director |
Mar 1, 2008 | ||
| Michelle Hendricks |
Corporate Officer |
Jan 1, 2024 | |
| Michael Waller |
Corporate Officer |
Jan 1, 2024 | |
| W-2 Managing Employee |
Jan 1, 2024 | ||
| Darren Grove |
Corporate Officer |
Aug 26, 2022 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20221118000803 | MO | Part a Provider - Federally Qualified Health Center (FQHC) | 8224926092 | Practice locations: Warsaw, MO |
National Provider Directory
- Tax ID family
- Community Free Clinic I
Locations
1825 Atchison Ave
Marshall, MO 65340
Phone (660) 886-3434
313 E Eastwood St
Marshall, MO 65340
Phone (660) 886-7100
1700 E Broadway Blvd
Sedalia, MO 65301
913 W Newton St
Versailles, MO 65084
Phone (573) 378-4231
519 E Jefferson St
Warsaw, MO 65355
Phone (660) 438-2717
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
20363 Lane of Champions
Warsaw, MO 65355-6463
Mailing address
821 Westwood Dr
Sedalia, MO 65301-2102
Phone (660) 826-4774
Other names
- Katy Trail - Warsaw School
Other providers in Warsaw, MO
- Jaime L Reed
- Regional Health Care Clinic
- Regional Health Care Clinic Inc
- Regional Health Care Clinic Inc
- Regional Health Care Clinic Inc
- Regional Health Care Clinic, Inc
- Tyrel Reichert
- Tami Anne Rembolt
- Robert Rensch
- Rivers Edge Care Home LLC
All providers in Warsaw, MO · Federally Qualified Health Center (FQHC) in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 21, 2024. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.