Provider Demographics
NPI:1972001386
Name:COMMUNITY HEALTH CTR OF CENTRAL MISSOURI
Entity Type:Organization
Organization Name:COMMUNITY HEALTH CTR OF CENTRAL MISSOURI
Other - Org Name:COMMUNITY HEALTH CENTER OF CENTRAL MISSOURI-CHRISTY DRIVE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:TOBY
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-632-2777
Mailing Address - Street 1:PO BOX 104780
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65110-4780
Mailing Address - Country:US
Mailing Address - Phone:573-632-2777
Mailing Address - Fax:573-632-0248
Practice Address - Street 1:1511 CHRISTY DR
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65101-2854
Practice Address - Country:US
Practice Address - Phone:573-632-2777
Practice Address - Fax:573-632-2769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-31
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty