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NPI Code Detail

MEDICARE: RICHLAND MEDICAL CENTER, INC.

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
1261QF0400XFederally Qualified Health Center (FQHC)

General Provider Information

NPI Number : 1710485024
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 : 1501 SCHOOL RD
Second Line :
City : LAKE OZARK
State : MO
Zip : 65049-9761
Country : US
Telephone Number : 573-765-5131
Fax Number : 573-765-3122
Authorized Official
Title or Position : CEO
Name : KELLY MILLER
Credential :
Telephone Number : 573-836-7071
Provider Enumeration Date : 02/01/2018
Last Update Date : 02/03/2022

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