NPIMap

Organization Active NPI

Pike County Memorial Hospital

Doing business as PCMH Clinic

  • Family Medicine Physician
  • Vandalia, MO
National Provider Identifier
1891201331
Registry record updated Dec 20, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PIKE COUNTY MEMORIAL HOSPITAL
Doing business as
PCMH Clinic
Practice address
425 N Galloway Rd
Vandalia, MO 63382-1259
Phone
(573) 594-2111
NPI assigned
Dec 20, 2017
Last updated
Dec 20, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2017

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

Authorized official

Name
Justin Selle
Title
Ceo
Phone
(573) 754-5531

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

425 N Galloway Rd
Vandalia, MO 63382-1259

Mailing address

2305 Georgia St
Louisiana, MO 63353-2559
Phone (573) 754-5531

Other names 1

  • PCMH Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Eastern Missouri Helath8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

NPI Registry JSON

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

{
    "created_epoch": "1513728000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1513728000000",
    "number": "1891201331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2305 GEORGIA ST",
            "city": "LOUISIANA",
            "state": "MO",
            "postal_code": "633532559",
            "telephone_number": "573-754-5531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 N GALLOWAY RD",
            "city": "VANDALIA",
            "state": "MO",
            "postal_code": "633821259",
            "telephone_number": "573-594-2111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PIKE COUNTY MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-20",
        "last_updated": "2017-12-20",
        "status": "A",
        "authorized_official_last_name": "SELLE",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "573-754-5531"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PCMH Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Vandalia, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2017; 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.