Provider Demographics
NPI:1518588896
Name:SOUTH CENTRAL MISSOURI COMMUNITY HEALTH CENTER
Entity Type:Organization
Organization Name:SOUTH CENTRAL MISSOURI COMMUNITY HEALTH CENTER
Other - Org Name:YOUR COMMUNITY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STUART
Authorized Official - Middle Name:
Authorized Official - Last Name:GIPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-426-6714
Mailing Address - Street 1:414 W JAMES BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:MO
Mailing Address - Zip Code:65559-1219
Mailing Address - Country:US
Mailing Address - Phone:573-265-8402
Mailing Address - Fax:
Practice Address - Street 1:414 W JAMES BLVD
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:MO
Practice Address - Zip Code:65559-1219
Practice Address - Country:US
Practice Address - Phone:573-265-8402
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTH CENTRAL MISSOURI COMMUNITY HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-04-28
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)