Healthcare Provider Details

I. General information

NPI: 1346079613
Provider Name (Legal Business Name): SOUTH CENTRAL MISSOURI COMMUNITY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2024
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 S BISHOP AVE
ROLLA MO
65401-4411
US

IV. Provider business mailing address

1081 E 18TH ST
ROLLA MO
65401-2448
US

V. Phone/Fax

Practice location:
  • Phone: 573-426-4455
  • Fax: 573-426-6723
Mailing address:
  • Phone: 573-426-4455
  • Fax: 573-426-6723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: STUART GIPSON
Title or Position: CEO
Credential:
Phone: 573-426-4455