MISSOURI DELTA MEDICAL CENTER (NPI# 1790855401) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790855401 |
| Entity Type | Organization |
| Organization Name | MISSOURI DELTA MEDICAL CENTER |
| Other Organization Name | COMMUNITY CARE CENTER |
| Practice Address |
1403 E Marshall St Charleston MO 63834-1446 |
| Mailing Address |
1008 North Main Sikeston MO 63801-5044 |
| Practice Telephone | 5736832327 |
| Practice Fax Number | 5736832373 |
| Mailing Telephone | 5734711600 |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2015-03-12 |
| Authorized Official Name | JASON SCHRUMPF (CEO/PRESIDENT) |
| Authorized Official Telephone | 5734727601 |
| Is Organization Subpart | Y |
| Parent Organization Name | MISSOURI DELTA MEDICAL CENTER |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 282N00000X | General Acute Care Hospital | 100-49 | MO | Hospitals |
| Y | 261QR1300X |
Clinic/Center Specialization: Rural Health |
100-49 | MO | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | 010418903 | 05 |
| Other Name | Type Code |
|---|---|
| Community Care Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427572007 | Missouri Delta Medical Center | Clinic/Center | 209 W Yoakum Ave, Chaffee, MO 63740-1138 | 2017-07-26 |
| 1093265159 | Missouri Delta Medical Center | General Acute Care Hospital | 2856 Vista Ridge Pl, Jackson, MO 63755-8105 | 2016-10-12 |
| 1013236421 | Missouri Delta Medical Center | Clinic/Center | 1013 North Main, Sikeston, MO 63801 | 2010-05-25 |
| 1871663583 | Missouri Delta Medical Center | General Acute Care Hospital | 1008 North Main, Sikeston, MO 63801-5044 | 2006-11-09 |
| 1609230507 | Missouri Delta Medical Center | Clinic/Center | 6468 State Highway 77, Benton, MO 63736-8237 | 2016-04-07 |
| 1821462284 | Missouri Delta Medical Center | Clinic/Center | 1008 N Main St, Sikeston, MO 63801-5044 | 2015-11-23 |
| 1043628704 | Missouri Delta Medical Center | Pharmacy | 1008 N Main St, Sikeston, MO 63801-5044 | 2014-07-25 |
| 1972944593 | Missouri Delta Medical Center | Family Medicine | 615 Main St, New Madrid, MO 63869-1513 | 2013-07-11 |
| 1568703130 | Missouri Delta Medical Center | Family Medicine | 204 E 3rd St, Portageville, MO 63873-1402 | 2013-03-07 |
| 1215240965 | Missouri Delta Medical Center | Durable Medical Equipment & Medical Supplies | 1008 N Main St, Sikeston, MO 63801-5044 | 2010-07-23 |
| Street Address |
1403 E MARSHALL ST |
| City | CHARLESTON |
| State | MO |
| Zip Code | 63834-1446 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568979722 | Twan Robinson | Social Worker | 1403 E Marshall St, Charleston, MO 63834-1446 | 2018-01-09 |
| 1851551907 | Jeffrey Griesemer | Family Medicine | 1403 E Marshall St, Charleston, MO 63834 | 2008-06-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215268404 | Lori J Blankenship | Nurse Practitioner | 1403 East Marshall, Charleston, MO 63834 | 2010-01-27 |
| 1548319759 | Donald Allen Raithel | Chiropractor | 110 West Commercial Ave, Charleston, MO 63834 | 2007-01-09 |
| 1790883064 | Gregorio Lerma Rodriguez | Family Medicine | 1403 E. Marshall Street, Charleston, MO 63834 | 2006-09-20 |
| 1194830760 | Ronald Lee Petersen | Dentist | 104 North Main St, Charleston, MO 63834 | 2006-08-21 |
| 1376068114 | Bianca Daisy | Pharmacist | 406 S. Main Street, Charleston, MO 63834 | 2017-08-12 |
| 1871815597 | Gregorio L. Rodriguez, M.d., P.C. | Family Medicine | 1403 E. Marshall Street, Charleston, MO 63834 | 2010-02-22 |
| 1982968681 | Rebecca Chapman | Chiropractor | 204 N 1st St, Charleston, MO 63834-1100 | 2012-06-27 |
| 1184988834 | Charleston Chiropractic LLC | Chiropractor | 204 N 1st St, Charleston, MO 63834-1100 | 2012-06-27 |
| 1992094825 | Sharon Leslie Mcghee | Counselor | 801 E Marshall St, Charleston, MO 63834-1262 | 2011-03-31 |
| 1356813257 | Mississippi County Health Department | Public Health or Welfare | 1200 E Marshall St, Charleston, MO 63834-1336 | 2018-12-18 |
| Find all providers in zip 63834 | ||||
| Taxonomy Code | 261QR1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rural Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316152010 | Wolfe Family Medical Clinic Pllc | Clinic/Center | 203 E Walnut St, Charleston, MS 38921 | 2007-05-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871102137 | Washington County Memorial Hospital | Clinic/Center | 14206 Hwy C, Belgrade, MO 63622 | 2020-07-23 |
| 1891325072 | Scotland County Memorial Hospital | Clinic/Center | 55682 State Highway 6 Ste A, Edina, MO 63537-4268 | 2020-01-16 |
| 1639736457 | Southeast Health Center of Stoddard County LLC | Clinic/Center | 800 Us Highway 61, New Madrid, MO 63869-1106 | 2019-05-28 |
| 1134633456 | Pike County Memorial Hospital | Clinic/Center | 1420 S Business 61 Unit Fde, Bowling Green, MO 63334-5230 | 2017-11-22 |
| 1720505894 | Perry County Health System | Clinic/Center | 210 Hospital Ln Ste 202, Perryville, MO 63775-4200 | 2017-08-29 |
| 1427572007 | Missouri Delta Medical Center | Clinic/Center | 209 W Yoakum Ave, Chaffee, MO 63740-1138 | 2017-07-26 |
| 1790213676 | Jackson Primary Care LLC | Clinic/Center | 2685 E Main St Ste A, Jackson, MO 63755-2474 | 2017-05-23 |
| 1972050581 | Sgoh Acquisition, Inc. | Clinic/Center | 912b State Highway 59, Goodman, MO 64843-8252 | 2016-09-01 |
| 1144605312 | Nevada City Hospital | Clinic/Center | 627 S Ash St Ste B, Nevada, MO 64772 | 2015-07-29 |
| 1669856829 | Ssm Regional Health Services | Clinic/Center | 2511 W Edgewood Dr Ste F, Jefferson City, MO 65109-5869 | 2015-07-16 |
| Find all providers with the same taxonomy | ||||
| City | CHARLESTON |
| Zip Code | 63834 |
Please comment or provide details below to improve the information on MISSOURI DELTA MEDICAL CENTER.
| 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.