NPIMap

Organization Active NPI

Mid America Healthcare LP

Doing business as Marymount Manor Skilled Nursing Facility

  • Skilled Nursing Facility
  • Eureka, MO
National Provider Identifier
1982689485
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
031632 Issued in MO
Legal business name
MID AMERICA HEALTHCARE LP
Doing business as
Marymount Manor Skilled Nursing Facility
Practice address
313 Augustine Rd
Eureka, MO 63025-1935
Phone
(636) 938-6770
Fax
(636) 938-3742
NPI assigned
Dec 7, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Charles J Riley
Title
Managing Partner
Phone
(636) 349-2311

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 031632 MO Primary

Addresses

Primary practice location

313 Augustine Rd
Eureka, MO 63025-1935

Mailing address

1749 Gilsinn LN
Fenton, MO 63026-2003
Phone (636) 349-2311

Other names 1

  • Marymount Manor Skilled Nursing Facility Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Mid America Healthcare LP4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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": "1133913600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1982689485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1749 GILSINN LN",
            "city": "FENTON",
            "state": "MO",
            "postal_code": "630262003",
            "telephone_number": "636-349-2311",
            "fax_number": "636-349-6491"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "313 AUGUSTINE RD",
            "city": "EUREKA",
            "state": "MO",
            "postal_code": "630251935",
            "telephone_number": "636-938-6770",
            "fax_number": "636-938-3742"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID AMERICA HEALTHCARE LP",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-07",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "RILEY",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "636-349-2311",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MO",
            "license": "031632",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Marymount Manor Skilled Nursing Facility",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Eureka, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.