NPIMap

Organization Active NPI

Northeast Missouri Health Council, Inc.

Doing business as Northeast Missouri Dental Clinic

  • Federally Qualified Health Center (FQHC)
  • Kirksville, MO
National Provider Identifier
1972649986
Registry record updated Oct 12, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
NORTHEAST MISSOURI HEALTH COUNCIL, INC.
Doing business as
Northeast Missouri Dental Clinic
Practice address
402 W Jefferson St
Kirksville, MO 63501-3407
Phone
(660) 665-2741
Fax
(660) 665-3109
NPI assigned
Jan 29, 2007
Last updated
Oct 12, 2012By the provider in NPPES
Organization subpart
Yes
Parent organization
NORTHEAST MISSOURI HEALTH COUNCIL, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 12, 2012

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

Authorized official

Name
Andrew H. Grimm
Title
Executive Director
Phone
(660) 627-5757

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Public Health DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223D0001X 2001012903 MO
Public Health DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223D0001X 2006007559 MO
Dental HygienistGroup: 193200000X MULTI-SPECIALTY GROUP 124Q00000X 003847 MO
Federally Qualified Health Center (FQHC) 261QF0400X MO Primary

Addresses

Primary practice location

402 W Jefferson St
Kirksville, MO 63501-3407

Mailing address

1416 Crown Dr
P O Box 1027
Kirksville, MO 63501-2548
Phone (660) 627-5757

Other names 1

  • Northeast Missouri Dental Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Northeast Mo Family HLT13 organizations share this tax ID, including this one
Part of
Northeast Mo Family HLT

Other organizations with this tax ID 12

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": "1170028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350000000000",
    "number": "1972649986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1416 CROWN DR",
            "address_2": "P O BOX 1027",
            "city": "KIRKSVILLE",
            "state": "MO",
            "postal_code": "635012548",
            "telephone_number": "660-627-5757",
            "fax_number": "660-627-5802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "402 W JEFFERSON ST",
            "city": "KIRKSVILLE",
            "state": "MO",
            "postal_code": "635013407",
            "telephone_number": "660-665-2741",
            "fax_number": "660-665-3109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST MISSOURI HEALTH COUNCIL, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NORTHEAST MISSOURI HEALTH COUNCIL, INC.",
        "enumeration_date": "2007-01-29",
        "last_updated": "2012-10-12",
        "status": "A",
        "authorized_official_last_name": "GRIMM",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_middle_name": "H.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "660-627-5757"
    },
    "taxonomies": [
        {
            "code": "1223D0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Dental Public Health",
            "state": "MO",
            "license": "2001012903",
            "primary": false
        },
        {
            "code": "1223D0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Dental Public Health",
            "state": "MO",
            "license": "2006007559",
            "primary": false
        },
        {
            "code": "124Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dental Hygienist",
            "state": "MO",
            "license": "003847",
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "MO",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northeast Missouri Dental Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kirksville, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2012; 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.