Provider Demographics
NPI:1457120669
Name:RICHLAND MEDICAL CENTER, INC
Entity type:Organization
Organization Name:RICHLAND MEDICAL CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-836-7071
Mailing Address - Street 1:PO BOX 777
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:MO
Mailing Address - Zip Code:65556-0777
Mailing Address - Country:US
Mailing Address - Phone:573-677-4425
Mailing Address - Fax:573-723-1474
Practice Address - Street 1:101 12TH ST
Practice Address - Street 2:
Practice Address - City:CROCKER
Practice Address - State:MO
Practice Address - Zip Code:65452-9203
Practice Address - Country:US
Practice Address - Phone:877-406-2662
Practice Address - Fax:573-765-3824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-28
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)