Pemiscot County Memorial Hospital

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

PEMISCOT COUNTY MEMORIAL HOSPITAL

Doing business as

Portageville Primary Care Center

Practice address

314 E Main St
Portageville, MO 63873-1616

Phone

(573) 379-3777

Fax

(573) 379-9331

NPI assigned

Sep 20, 2006

Organization subpart

No

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

Authorized official

Name

Mark R Davis

Title

Ceo

Phone

(573) 359-3612

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Portageville Primary Care Center Doing business as

Member of 1

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

• Pemiscot County Memorial Hospital

  dba Pemiscot Primary Care Center

  • Rural Health Clinic/Center
  • Hayti, MO
  • NPI 1518065291

  Member Of

  NPD member

Locations

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1463011200000",
    "number": "1699873372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "314 E MAIN ST",
            "city": "PORTAGEVILLE",
            "state": "MO",
            "postal_code": "638731616",
            "telephone_number": "573-379-3777",
            "fax_number": "573-379-9331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "314 E MAIN ST",
            "city": "PORTAGEVILLE",
            "state": "MO",
            "postal_code": "638731616",
            "telephone_number": "573-379-3777",
            "fax_number": "573-379-9331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEMISCOT COUNTY MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2016-05-12",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "573-359-3612"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "596948109",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Portageville Primary Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jaelyn Alexis Milam, PTA
• Missouri Bootheel Regional Consortium, Inc.
• Missouri Delta Medical Center (Portageville Community Care Center)
• David W Morris
• N & R of Portageville, Inc. (Portageville Nursing Center)
• Portageville Health Care Center, L.L.C. (Portageville Health Care Center)
• Portageville Nursing and Rehabilitation, LLC
• Portageville School District
• Portageville SNF Opco LLC (Portageville Health Care Center)
• Dennis Reed, PA

• Rural Health Clinic/Center in Portageville, MO
• Providers in Portageville, MO by specialty
• Rural Health Clinic/Center in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2016; 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.