NPIMap

Organization Active NPI

Great Mines Health Center

  • Federally Qualified Health Center (FQHC)
  • Leadwood, MO
National Provider Identifier
1801446109
Registry record updated Sep 18, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
GREAT MINES HEALTH CENTER
Practice address
206 Church Street
Room4
Leadwood, MO 63653-1132
Phone
(573) 438-9355
Fax
(573) 438-7892
NPI assigned
Sep 18, 2019
Last updated
Sep 18, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2019

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

Authorized official

Name
Gregory Roeback, MA, NCC, LPC, PHR, SNPI 1033683354
Title
Ceo
Phone
(573) 438-9355

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

206 Church Street
Room4
Leadwood, MO 63653-1132

Mailing address

PO Box 761
Potosi, MO 63664-0761
Phone (573) 438-9355

Other identifiers 1

IdentifierTypeStateIssuer
H80CS066701404OtherHRSA

Other names 1

  • Great Mines-West County Community Hope Center Clinic Other name

National Provider Directory

National Provider Directory
Tax ID family
Great Mines Health Center22 organizations share this tax ID, including this one

Other organizations with this tax ID 21

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

View all 21

Locations

206 Church St
Rm 4
Leadwood, MO 63653

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": "1568764800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1568764800000",
    "number": "1801446109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 761",
            "city": "POTOSI",
            "state": "MO",
            "postal_code": "636640761",
            "telephone_number": "573-438-9355",
            "fax_number": "573-438-7892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "206 CHURCH STREET",
            "address_2": "ROOM4",
            "city": "LEADWOOD",
            "state": "MO",
            "postal_code": "636531132",
            "telephone_number": "573-438-9355",
            "fax_number": "573-438-7892"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT MINES HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-18",
        "last_updated": "2019-09-18",
        "status": "A",
        "authorized_official_last_name": "ROEBACK",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "573-438-9355",
        "authorized_official_credential": "MA, NCC, LPC, PHR, S"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HRSA",
            "identifier": "H80CS066701404",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Great Mines-West County Community Hope Center Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Leadwood, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2019; 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.