MEDICARE: SOUTH CENTRAL MISSOURI COMMUNITY HEALTH CENTER

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	:	1518588896
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH CENTRAL MISSOURI COMMUNITY HEALTH CENTER

Provider Business Mailing Address
First Line	:	414 W JAMES BLVD
Second Line	:
City	:	SAINT JAMES
State	:	MO
Zip	:	65559-1219
Country	:	US
Telephone Number	:	573-265-8402
Fax Number	:

Provider Business Practice Location Address
First Line	:	414 W JAMES BLVD
Second Line	:
City	:	SAINT JAMES
State	:	MO
Zip	:	65559-1219
Country	:	US
Telephone Number	:	573-265-8402
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	STUART GIPSON
Credential	:
Telephone Number	:	573-426-6714

Provider Enumeration Date	:	04/28/2020
Last Update Date	:	06/01/2020

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