Provider Demographics
NPI:1700337771
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:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:BEECHNERMCCARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-458-8644
Mailing Address - Street 1:1081 E 18TH ST
Mailing Address - Street 2:PO BOX 458
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65401-2448
Mailing Address - Country:US
Mailing Address - Phone:573-458-8644
Mailing Address - Fax:573-426-2263
Practice Address - Street 1:1081 E 18TH ST
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-2448
Practice Address - Country:US
Practice Address - Phone:573-458-8644
Practice Address - Fax:573-426-2263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-14
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1164669172Medicaid