Great Mines Health Center

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

GREAT MINES HEALTH CENTER

Practice address

10788 State Highway a RM 128
Richwoods, MO 63071-2548

Phone

(573) 438-9355

Fax

(573) 438-7892

NPI assigned

Jan 22, 2019

Last updated

Jan 22, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Gregory A Roeback, MA, NCC, LPC, PHR, SNPI 1033683354

Title

Chief Executive Officer

Phone

(573) 438-9355

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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.

• Gregory A Roeback, LPC

  • Professional Counselor
  • Potosi, MO
  • NPI 1033683354
  Authorized official Same address or phone

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

{
    "created_epoch": "1548115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548115200000",
    "number": "1922562172",
    "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": "573-435-9355",
            "fax_number": "573-438-7892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10788 STATE HIGHWAY A RM 128",
            "city": "RICHWOODS",
            "state": "MO",
            "postal_code": "630712548",
            "telephone_number": "573-438-9355",
            "fax_number": "573-438-7892"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT MINES HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-22",
        "last_updated": "2019-01-22",
        "status": "A",
        "authorized_official_last_name": "ROEBACK",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "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": "H80CS06670-13-02",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kathleen Delain Decker, AGPCNP-BC
• Ashley Evans, COTA/L
• Jesse Dwayne Helton (Byrnes Mill Medical Center-Richwoods)
• Richwoods R-VII

• Federally Qualified Health Center (FQHC) in Richwoods, MO
• Providers in Richwoods, MO by specialty
• Federally Qualified Health Center (FQHC) in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 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.