NPIMap

Organization Active NPI

Pike County Memorial Hospital

Doing business as Medical Walk-In Clinic

  • Family Medicine Physician
  • Bowling Green, MO
National Provider Identifier
1962933143
Registry record updated Apr 4, 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
Medical Walk-In Clinic
Practice address
1420 S Business 61
Unit Fde
Bowling Green, MO 63334-5230
Phone
(573) 754-5531
NPI assigned
Mar 21, 2017
Last updated
Apr 4, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 4, 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 Physician 207Q00000X Primary

Addresses

Primary practice location

1420 S Business 61
Unit Fde
Bowling Green, MO 63334-5230

Mailing address

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

Other names 1

  • Medical Walk-In Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050407000376 MO Part B Supplier - Clinic/Group Practice 8123015518 Receives reassigned benefits from 31 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Vandalia, MO; Bowling Green, MO

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

1420 S Business 61
Ste E
Bowling Green, MO 63334

1420 S Business Highway 61
Ste D
Bowling Green, MO 63334
Phone (573) 324-6012

2855 Veterans Memorial Pkwy
Saint Charles, MO 63303
Phone (636) 925-1143

Practitioners & affiliated clinicians

Practitioners 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1490054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1491264000000",
    "number": "1962933143",
    "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": "1420 S BUSINESS 61",
            "address_2": "UNIT FDE",
            "city": "BOWLING GREEN",
            "state": "MO",
            "postal_code": "633345230",
            "telephone_number": "573-754-5531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PIKE COUNTY MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-21",
        "last_updated": "2017-04-04",
        "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": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medical Walk-In Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bowling Green, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.