Healthcare Provider Details

I. General information

NPI: 1972001386
Provider Name (Legal Business Name): COMMUNITY HEALTH CTR OF CENTRAL MISSOURI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2018
Last Update Date: 10/27/2023
Certification Date: 10/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1511 CHRISTY DR
JEFFERSON CITY MO
65101-2854
US

IV. Provider business mailing address

PO BOX 104780
JEFFERSON CITY MO
65110-4780
US

V. Phone/Fax

Practice location:
  • Phone: 573-632-2777
  • Fax: 573-632-2769
Mailing address:
  • Phone: 573-632-2777
  • Fax: 573-632-0248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. TOBY BARNETT
Title or Position: CFO
Credential:
Phone: 573-632-2777