Pemiscot County Memorial Hospital

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

PEMISCOT COUNTY MEMORIAL HOSPITAL

Doing business as

Bootheel Primary Care Clinic - Kennett

Practice address

1231 1St St Ste 5
Kennett, MO 63857-2521

Phone

(573) 888-8828

Fax

(573) 888-8830

NPI assigned

Sep 5, 2006

Last updated

Aug 7, 2024By 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

Lauren Turnage

Title

Revenue Cycle Director

Phone

(573) 359-3498

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Bootheel Primary Care Clinic - Kennett Doing business as

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Other NPIs on the same Medicare enrollment 4

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

• Pemiscot County Memorial Hospital

  dba Pemiscot Primary Care Center

  • Rural Health Clinic/Center
  • Hayti, MO
  • NPI 1518065291

  O20070326000204

  Same enrollment
• Pemiscot County Memorial Hospital

  dba Bootheel Primary Care Clinic - Steele

  • Rural Health Clinic/Center
  • Steele, MO
  • NPI 1558514901

  O20070326000204

  Same enrollment
• Pemiscot County Memorial Hospital

  • Emergency Care Clinic/Center
  • Hayti, MO
  • NPI 1578668661

  O20070326000204

  Same enrollment
• Pemiscot County Memorial Hospital

  dba Pemiscot Specialty Clinic

  • Clinic/Center
  • Hayti, MO
  • NPI 1942881834

  O20070326000204

  Same enrollment

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Pemiscot County Memorial Hospital

  • Rural Acute Care Hospital
  • Hayti, MO
  • NPI 1437179710

  Member Of

  NPD member

Locations

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

{
    "created_epoch": "1157414400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722988800000",
    "number": "1992807390",
    "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": "1231 1ST ST STE 5",
            "city": "KENNETT",
            "state": "MO",
            "postal_code": "638572521",
            "telephone_number": "573-888-8828",
            "fax_number": "573-888-8830"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEMISCOT COUNTY MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-05",
        "last_updated": "2024-08-07",
        "certification_date": "2024-08-07",
        "status": "A",
        "authorized_official_last_name": "TURNAGE",
        "authorized_official_first_name": "LAUREN",
        "authorized_official_title_or_position": "REVENUE CYCLE DIRECTOR",
        "authorized_official_telephone_number": "573-359-3498"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "598517803",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bootheel Primary Care Clinic - Kennett",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Bootheel Primary Care Clinic - Kennett",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Traci Patterson, P.T.
• Sharon Ann Payne, FNP-C
• Allison Ann Peck, RN
• Jerris Jean Pelts
• Pemiscot County Memorial Hospital (Bootheel Family Practice)
• Nelson R Perez, MD
• Chandra Celeste Perkins-Shannon
• Legusta Renee Perkins
• Angela Peters
• Elaina Danielle Phelps

• Rural Health Clinic/Center in Kennett, MO
• Providers in Kennett, MO by specialty
• Rural Health Clinic/Center in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2024; 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.