Provider Demographics
NPI:1538213244
Name:COMMUNITY HEALTH CTR OF CENTRAL MISSOURI
Entity type:Organization
Organization Name:COMMUNITY HEALTH CTR OF CENTRAL MISSOURI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FIN OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TOBY
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-632-0243
Mailing Address - Street 1:P.O. BOX 104780
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65110-4780
Mailing Address - Country:US
Mailing Address - Phone:573-632-0243
Mailing Address - Fax:573-632-6900
Practice Address - Street 1:316 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:LINN
Practice Address - State:MO
Practice Address - Zip Code:65051
Practice Address - Country:US
Practice Address - Phone:573-897-4946
Practice Address - Fax:573-897-4941
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY HEALTH CTR OF CENTRAL MISSOURI
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-22
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO507340115Medicaid
26-1011OtherMEDICARE
MO507340107Medicaid
26-1011OtherMEDICARE
MO507340107Medicaid
MO507340115Medicaid