Active NPI
Pemiscot County Memorial Hospital
Doing business as Bootheel Primary Care New Madrid
- Rural Health Clinic/Center
- New Madrid, MO
National Provider Identifier
1932372646
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rural Health Clinic/Center
- Legal business name
- PEMISCOT COUNTY MEMORIAL HOSPITAL
- Doing business as
- Bootheel Primary Care New Madrid
- Practice address
- 555 Virginia Ave
New Madrid, MO 63869 - Phone
- (573) 748-3107
- Fax
- (573) 748-3112
- NPI assigned
- Apr 3, 2008
- Last updated
- Jun 22, 2018
- Organization subpart
- Yes
- Parent organization
- PEMISCOT COUNTY MEMORIAL HOSPITAL
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Cathy Lacey
- Title
- Credentialing Director
- Phone
- (573) 359-3659
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | MO | Primary |
Addresses
Primary practice location
555 Virginia Ave
New Madrid, MO 63869
Mailing address
PO Box 442
Hayti, MO 63851-0442
Phone (573) 359-3659
Other practice location 1
310 E Main St
Hayti, MO 63851-1639
Phone (573) 359-2019
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 597723402 | Medicaid | MO |
Other names 1
- Bootheel Primary Care New Madrid
National Provider Directory
National Provider Directory- Part of
- W O Bryant MD
Member of 1
Organizations this organization is a member of, according to the National Provider Directory.
-
dba Pemiscot Memorial Hospital-Swing
- Medicare Defined Swing Bed Hospital Unit
- Hayti, MO
- NPI 1972611218
Member Of
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1207180800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1529625600000",
"number": "1932372646",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 442",
"city": "HAYTI",
"state": "MO",
"postal_code": "638510442",
"telephone_number": "573-359-3659",
"fax_number": "573-359-3608"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "555 VIRGINIA AVE",
"city": "NEW MADRID",
"state": "MO",
"postal_code": "63869",
"telephone_number": "573-748-3107",
"fax_number": "573-748-3112"
}
],
"practiceLocations": [
{
"address_1": "310 E Main St",
"address_purpose": "LOCATION",
"city": "Hayti",
"state": "MO",
"postal_code": "638511639",
"country_code": "US",
"telephone_number": "573-359-2019",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"organization_name": "PEMISCOT COUNTY MEMORIAL HOSPITAL",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "PEMISCOT COUNTY MEMORIAL HOSPITAL",
"enumeration_date": "2008-04-03",
"last_updated": "2018-06-22",
"status": "A",
"authorized_official_last_name": "LACEY",
"authorized_official_first_name": "CATHY",
"authorized_official_title_or_position": "CREDENTIALING DIRECTOR",
"authorized_official_telephone_number": "573-359-3659"
},
"taxonomies": [
{
"code": "261QR1300X",
"taxonomy_group": "",
"desc": "Clinic/Center, Rural Health",
"state": "MO",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "597723402",
"state": "MO"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Bootheel Primary Care New Madrid",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in New Madrid, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.