MEDICARE: RICHLAND MEDICAL CENTER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1659795102
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHLAND MEDICAL CENTER, INC.

Provider Business Mailing Address
First Line	:	PO BOX 777
Second Line	:
City	:	RICHLAND
State	:	MO
Zip	:	65556-0777
Country	:	US
Telephone Number	:	573-765-5131
Fax Number	:	573-765-3122

Provider Business Practice Location Address
First Line	:	948 E US HIGHWAY 54
Second Line	:
City	:	CAMDENTON
State	:	MO
Zip	:	65020-6834
Country	:	US
Telephone Number	:	573-346-4446
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	MR. ROBERT F STEELE
Credential	:
Telephone Number	:	573-480-7844

Provider Enumeration Date	:	02/04/2014
Last Update Date	:	06/08/2015

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