MOSAIC MEDICAL CENTER - MARYVILLE (NPI# 1821562265) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1821562265 |
| Entity Type | Organization |
| Organization Name | MOSAIC MEDICAL CENTER - MARYVILLE |
| Other Organization Name | MOSAIC SPECIALTY CARE - WEST |
| Practice Address |
2016 S Main St Maryville MO 64468-2655 |
| Practice Telephone | 6605622525 |
| Practice Fax Number | 6605264303 |
| Mailing Telephone | 6605622525 |
| Mailing Fax Number | 6605264303 |
| Enumeration Date | 2019-01-18 |
| Last Update Date | 2019-03-01 |
| Authorized Official Name | DWIGHT R CARVELL (DIRECTOR OF REIMBURSEMENT) |
| Authorized Official Telephone | 8162730473 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR1300X |
Clinic/Center Specialization: Rural Health |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Mosaic Specialty Care - West | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093289431 | Mosaic Medical Center - Maryville | Family Medicine | 301 E Price Ave Ste A, Savannah, MO 64485-2482 | 2019-01-18 |
| 1184189797 | Mosaic Medical Center - Maryville | Internal Medicine | 2016 S Main St, Maryville, MO 64468-2655 | 2019-02-07 |
| 1205300498 | Mosaic Medical Center - Maryville | Family Medicine | 408 Dodge St, Bedford, IA 50833-1413 | 2019-01-22 |
| 1598239790 | Mosaic Medical Center - Maryville | Family Medicine | 114 E South Hills Dr, Maryville, MO 64468-2659 | 2019-01-22 |
| 1568936995 | Mosaic Medical Center - Maryville | Medicare Defined Swing Bed Unit | 2016 S Main St, Maryville, MO 64468-2655 | 2019-01-18 |
| 1477027803 | Mosaic Medical Center - Maryville | Psychiatric Unit | 2016 S Main St, Maryville, MO 64468-2655 | 2019-01-18 |
| 1265906663 | Mosaic Medical Center - Maryville | General Acute Care Hospital | 2016 S Main St, Maryville, MO 64468-2655 | 2019-01-18 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | MOSAIC MEDICAL CENTER - MARYVILLE | 2016 S Main St, Maryville, MO 64468-2655 |
| Iowa Business Entities | MOSAIC MEDICAL CENTER - MARYVILLE | 2016 South Main, Maryville, MO 64468 |
| Street Address |
2016 S MAIN ST |
| City | MARYVILLE |
| State | MO |
| Zip Code | 64468-2655 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619970761 | Lorraine M Dodson | Specialist | 2016 S Main St, Maryville, MO 64468-2655 | 2005-05-23 |
| 1275183055 | Alison Sporleder | Family Medicine | 2016 S Main St, Maryville, MO 64468-2655 | 2019-09-13 |
| 1982251856 | Paula Goodridge | Family Medicine | 2016 S Main St, Maryville, MO 64468-2655 | 2019-08-24 |
| 1184189797 | Mosaic Medical Center - Maryville | Internal Medicine | 2016 S Main St, Maryville, MO 64468-2655 | 2019-02-07 |
| 1568936995 | Mosaic Medical Center - Maryville | Medicare Defined Swing Bed Unit | 2016 S Main St, Maryville, MO 64468-2655 | 2019-01-18 |
| 1477027803 | Mosaic Medical Center - Maryville | Psychiatric Unit | 2016 S Main St, Maryville, MO 64468-2655 | 2019-01-18 |
| 1265906663 | Mosaic Medical Center - Maryville | General Acute Care Hospital | 2016 S Main St, Maryville, MO 64468-2655 | 2019-01-18 |
| 1194241349 | Angela Nicole Williamson | Nurse Practitioner | 2016 S Main St, Maryville, MO 64468-2655 | 2017-08-18 |
| 1225577372 | Estella Myrick | Nurse Practitioner | 2016 S Main St, Maryville, MO 64468-2655 | 2017-02-21 |
| 1558737874 | Megan Augustine | Nurse Practitioner | 2016 S Main St, Maryville, MO 64468-2655 | 2015-08-20 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619315603 | William Sean Prescott | Counselor | 318 North Main, Maryville, MO 64468 | 2013-06-12 |
| 1215284617 | Janet Luzmoor | Counselor | 109 East Summit Dr, Maryville, MO 64468 | 2012-08-06 |
| 1629336177 | Kristi Renee White | Social Worker | 423 N Market St, Maryville, MO 64468 | 2012-05-02 |
| 1285942474 | Kyle William Bowers | Physical Therapist | 2016 South Main Street, Maryville, MO 64468 | 2010-09-22 |
| 1861600660 | Debra Anne Hopkins | Physical Therapist | 2416 South Main St, Maryville, MO 64468 | 2007-05-18 |
| 1023235975 | Susan Kay Grispino | Occupational Therapist | Area Cooperative for Educational Support, 1429 South Munn Avenue, Maryville, MO 64468 | 2007-04-20 |
| 1760542567 | North West Missouri State University | Clinic/Center | 800 University Drive, Maryville, MO 64468 | 2006-12-11 |
| 1528154994 | Bruce E Twaddle | Dentist | 231 Summit Drive, Maryville, MO 64468 | 2006-10-05 |
| 1669588075 | Stanley David Snyder | Dentist | 2825 South Main Street, Maryville, MO 64468 | 2006-08-21 |
| 1710906896 | Ileen Richey-arellin | Social Worker | 109 E Summit Drive, Family Guidance Center, Maryville, MO 64468 | 2006-07-19 |
| Find all providers in zip 64468 | ||||
| Taxonomy Code | 261QR1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rural Health |
| Definition to come... |
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|---|---|---|---|---|
| 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 |
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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.