GREAT MINES HEALTH CENTER (NPI# 1548750847) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1548750847 |
| Entity Type | Organization |
| Organization Name | GREAT MINES HEALTH CENTER |
| Practice Address |
10047 Diamond Rd Rm 809 Cadet MO 63630-9581 |
| Mailing Address |
Po Box 761 Potosi MO 63664-0761 |
| Practice Telephone | 5734384982 |
| Practice Fax Number | 5734381212 |
| Mailing Telephone | 5734359355 |
| Mailing Fax Number | 5734387892 |
| Enumeration Date | 2018-05-14 |
| Last Update Date | 2018-05-14 |
| Authorized Official Name | GREGORY A ROEBACK (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Telephone | 5734389355 |
| Authorized Official Credential | MA, NCC, LPC, PH |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
H80CS06670-13-02 | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| HRSA | H80CS06670-13-02 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790332757 | Great Mines Health Center | Clinic/Center | 625 Charlton Avenue, Room 103, Park Hills, MO 63601-9356 | 2019-08-23 |
| 1891341665 | Great Mines Health Center | Clinic/Center | 512 State St Rm 101, Mineral Point, MO 63660-8208 | 2019-08-16 |
| 1922562172 | Great Mines Health Center | Clinic/Center | 10788 State Highway A Rm 128, Richwoods, MO 63071-2548 | 2019-01-22 |
| 1669654638 | Great Mines Health Center | Family Medicine | 123 W Pratt St, De Soto, MO 63020-2107 | 2007-12-03 |
| 1376536953 | Great Mines Health Center | Clinic/Center | #1 Southtowne Drive, Potosi, MO 63664-1455 | 2005-08-29 |
| 1801446109 | Great Mines Health Center | Clinic/Center | 206 Church Street, Room4, Leadwood, MO 63653-1132 | 2019-09-18 |
| 1922446384 | Great Mines Health Center | Clinic/Center | 508 W Pine St, Farmington, MO 63640-1426 | 2013-06-07 |
| 1750563722 | Great Mines Health Center | Family Medicine | 530 N Middle St, Farmington, MO 63640-1570 | 2007-12-03 |
| Street Address |
10047 DIAMOND RD RM 809 |
| City | CADET |
| State | MO |
| Zip Code | 63630-9581 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396210852 | Catholic Charities of St. Louis | Family Medicine | 10120 Crest Rd., St. Joachim Catholic Church-attn: Rural Parish Clinic, Cadet, MO 63630 | 2018-10-10 |
| 1174189161 | Show-me Health Innovations LLC | Nursing Care | 10430 Tindall Rd, Cadet, MO 63630-8283 | 2019-05-15 |
| 1821620832 | Cygnus of St. Louis, LLC | Case Management | 10430 Tindall Rd, Cadet, MO 63630-8283 | 2020-02-07 |
| 1134786494 | Silvertip Medical Services, LLC | Clinic/Center | 10430 Tindall Rd, Cadet, MO 63630-8283 | 2019-05-22 |
| 1841413440 | Musaddeque Ahmad,md,pc | Clinic/Center | 10048 Settle Mill Rd, Cadet, MO 63630-9288 | 2007-04-11 |
| 1104040716 | Kingston School Dist 14 | Physical Therapist | 10047 Diamond Rd, Cadet, MO 63630-9581 | 2007-04-13 |
| 1154796647 | Andrea Dee Abeln | Speech-Language Pathologist | 10047 Diamond Rd, Cadet, MO 63630-9581 | 2015-12-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174189161 | Show-me Health Innovations LLC | Nursing Care | 10430 Tindall Rd, Cadet, MO 63630-8283 | 2019-05-15 |
| 1396210852 | Catholic Charities of St. Louis | Family Medicine | 10120 Crest Rd., St. Joachim Catholic Church-attn: Rural Parish Clinic, Cadet, MO 63630 | 2018-10-10 |
| 1841413440 | Musaddeque Ahmad,md,pc | Clinic/Center | 10048 Settle Mill Rd, Cadet, MO 63630-9288 | 2007-04-11 |
| 1821620832 | Cygnus of St. Louis, LLC | Case Management | 10430 Tindall Rd, Cadet, MO 63630-8283 | 2020-02-07 |
| 1134786494 | Silvertip Medical Services, LLC | Clinic/Center | 10430 Tindall Rd, Cadet, MO 63630-8283 | 2019-05-22 |
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
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| 1750912044 | Northwest Health Services, Inc. | Clinic/Center | 418 E 2nd St, Maryville, MO 64468-1703 | 2020-01-27 |
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| 1063052553 | Compass Health, Inc. | Clinic/Center | 1319 E Highway 24 Ste B, Moberly, MO 65270-3682 | 2020-01-13 |
| 1407490741 | Advocates for A Healthy Community Inc | Clinic/Center | 2238 W Kingsley St, Springfield, MO 65807-5456 | 2019-10-30 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.