Noble Health Audrain Inc

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

NOBLE HEALTH AUDRAIN INC

Doing business as

Audrain Comm Clinic

Practice address

600 Medical Park Dr
Mexico, MO 65265-3724

Phone

(573) 581-8500

Fax

(573) 581-5397

NPI assigned

Mar 16, 2021

Organization subpart

Yes

Parent organization

NOBLE HEALTH AUDRAIN INCAs reported in NPPES

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

Authorized official

Name

Amy L Obrien

Title

Ceo

Phone

(573) 582-5000

Specialties & licenses 1

Addresses

Other names 1

• Audrain Comm Clinic Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Rural health clinic certification: CCN 268555

Legal name

NOBLE HEALTH AUDRAIN MEDICAL GROUP

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Jan 3, 2003

Last certification

Oct 30, 2019

Ownership / control type

2A

Most recent change of ownership

Mar 16, 2021 (1 total)

Facility address

600 Medical Park Drive
Mexico, MO 65265

Related CCNs

260064

Part of

Audrain Comm Cancer Center

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Noble Health Audrain Inc

  dba Platinum Health Systems Audrain

  • General Acute Care Hospital
  • Mexico, MO
  • NPI 1891386504
  NPPES parent name

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

{
    "created_epoch": "1615852800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1655942400000",
    "number": "1801471255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 MEDICAL PARK DR",
            "city": "MEXICO",
            "state": "MO",
            "postal_code": "652653724",
            "telephone_number": "573-581-8500",
            "fax_number": "573-581-5397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 MEDICAL PARK DR",
            "city": "MEXICO",
            "state": "MO",
            "postal_code": "652653724",
            "telephone_number": "573-581-8500",
            "fax_number": "573-581-5397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOBLE HEALTH AUDRAIN INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NOBLE HEALTH AUDRAIN INC",
        "enumeration_date": "2021-03-16",
        "last_updated": "2022-06-23",
        "certification_date": "2022-06-23",
        "status": "A",
        "authorized_official_last_name": "OBRIEN",
        "authorized_official_first_name": "AMY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "573-582-5000"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Audrain Comm Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Noble Health Audrain Inc (Audrain Comm Specialty Clinic)
• Noble Health Audrain Inc (Platinum Health Systems Audrain)
• Noble Health Audrain Inc (Audrain Com Clinic Family Med)
• Noble Health Audrain Inc (Audrain Urgent Care Clinic)
• Noble Health Audrain Inc (Audrain Comm Womens Health)
• Noble Health Audrain Inc (Platinum Health Systems Audrain)
• Deanna Marie Nordwald, PTA
• James R Northern, DO
• Sarah Ogar, DPT
• Stephanie A Owings

• Rural Health Clinic/Center in Mexico, MO
• Providers in Mexico, 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 Jun 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.