SSM AUDRAIN HEALTH CARE, INC. (NPI# 1407865710) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407865710 |
| Entity Type | Organization |
| Organization Name | SSM AUDRAIN HEALTH CARE, INC. |
| Other Organization Name | SSM HEALTH MEDICAL GROUP - FAMILY MEDICINE |
| Practice Address |
240 Pickering St Montgomery City MO 63361-1967 |
| Mailing Address |
Po Box 478 Mexico MO 65265-0010 |
| Practice Telephone | 5735642101 |
| Practice Fax Number | 5735642130 |
| Mailing Telephone | 5735818127 |
| Mailing Fax Number | 5738527053 |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2020-09-02 |
| Authorized Official Name | GARRICK ELLIOTT MUELLER (CFO) |
| Authorized Official Telephone | 4052807582 |
| Is Organization Subpart | Y |
| Parent Organization Name | SSM AUDRAIN HEALTH CARE, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians | ||
| Y | 261QR1300X |
Clinic/Center Specialization: Rural Health |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | 598526408 | 05 |
| Other Name | Type Code |
|---|---|
| SSM Health Medical Group - Family Medicine | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801225982 | Ssm Audrain Health Care, Inc. | Clinic/Center | 201 S. Main, Auxvasse, MO 65231 | 2013-11-08 |
| 1255340246 | Ssm Audrain Health Care, Inc. | Family Medicine | 1223 Main Street, Perry, MO 63462 | 2006-08-07 |
| 1356712871 | Ssm Audrain Health Care, Inc. | Psychiatric Unit | 620 E Monroe St, Mexico, MO 65265-2919 | 2015-10-09 |
| 1336576008 | Ssm Audrain Health Care, Inc. | Obstetrics & Gynecology | 605 E Promenade St, Suite A, Mexico, MO 65265-2926 | 2013-09-26 |
| 1548520026 | Ssm Audrain Health Care, Inc. | Family Medicine | 221 N Main St, Paris, MO 65275-1328 | 2012-05-18 |
| 1336350214 | Ssm Audrain Health Care, Inc. | Family Medicine | 3626 S Clark St, Suite A, Mexico, MO 65265-4104 | 2007-05-24 |
| 1790838316 | Ssm Audrain Health Care, Inc. | Family Medicine | 3626 S Clark St, Mexico, MO 65265-4104 | 2007-01-18 |
| 1457469637 | Ssm Audrain Health Care, Inc. | Pediatrics | 3626 S Clark St Ste A, Mexico, MO 65265-4104 | 2006-08-28 |
| 1477563625 | Ssm Audrain Health Care, Inc. | Family Medicine | 625 E Summit St, Mexico, MO 65265-3294 | 2006-08-09 |
| 1871503466 | Ssm Audrain Health Care, Inc. | Internal Medicine | 600 Medical Park Dr, Mexico, MO 65265-3724 | 2006-08-08 |
| Street Address |
240 PICKERING ST |
| City | MONTGOMERY CITY |
| State | MO |
| Zip Code | 63361-1967 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528044153 | Gerald R. Deves | General Practice | 240 Pickering St, Montgomery City, MO 63361-1967 | 2005-12-15 |
| 1144648924 | Kristina Boylan | Nurse Practitioner | 240 Pickering St, Montgomery City, MO 63361-1941 | 2014-03-31 |
| 1588774889 | Michael Kinkade | Family Medicine | 240 Pickering St, Montgomery City, MO 63361-1941 | 2006-08-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508101338 | Charles Bukovac | Dentist | 215 South Sturgeon St, Montgomery City, MO 63361 | 2012-12-05 |
| 1265553820 | Thomas Robert Nichols | Dentist | 215 S Sturgeon, Suite C, Montgomery City, MO 63361 | 2007-04-02 |
| 1912999251 | Diana L Gibbs | Nurse Practitioner | 400 Salisbury St, Montgomery City, MO 63361-1232 | 2005-08-22 |
| 1467001248 | Preferred Family Healthcare Inc | Community/Behavioral Health | 400 Salisbury St, Montgomery City, MO 63361-1232 | 2019-09-05 |
| 1215440417 | Montgomery County Health Department | Public Health or Welfare | 400 Salisbury St, Montgomery City, MO 63361-1232 | 2017-11-09 |
| 1902892375 | Montgomery County Health Department | Public Health or Welfare | 400 Salisbury St, Montgomery City, MO 63361-1232 | 2005-09-21 |
| 1932114584 | Montgomery County Ambulance District | Ambulance | 911 Benton St, Montgomery City, MO 63361-1318 | 2006-07-30 |
| 1841346269 | Family Pharmacy | Pharmacy | 806 N Sturgeon St, Montgomery City, MO 63361-1426 | 2007-01-26 |
| 1255972196 | Family Pharmacy | Pharmacy | 806 N Sturgeon St, Montgomery City, MO 63361-1426 | 2019-10-02 |
| 1366940280 | Elizabeth A Holtman | Pharmacist | 806 N Sturgeon St, Montgomery City, MO 63361-1426 | 2018-01-25 |
| Find all providers in zip 63361 | ||||
| Taxonomy Code | 261QR1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rural Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811062375 | Hermann Area Hospital District | Clinic/Center | 504 N Sturgeon St, Montgomery City, MO 63361-1829 | 2006-11-21 |
| 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 | MONTGOMERY CITY |
| Zip Code | 63361 |
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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.