MEDICARE: GREAT MINES 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	:	1790332757
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREAT MINES HEALTH CENTER

Provider Business Mailing Address
First Line	:	PO BOX 761
Second Line	:
City	:	POTOSI
State	:	MO
Zip	:	63664-0761
Country	:	US
Telephone Number	:	573-438-9355
Fax Number	:	573-438-7892

Provider Business Practice Location Address
First Line	:	625 CHARITON AVE RM 103
Second Line	:
City	:	PARK HILLS
State	:	MO
Zip	:	63601-9356
Country	:	US
Telephone Number	:	573-438-9355
Fax Number	:	573-438-7892

Authorized Official
Title or Position	:	CEO
Name	:	GREGORY ROEBACK
Credential	:	MA,NCC,LPC,PHR,SHRMC
Telephone Number	:	573-438-9355

Provider Enumeration Date	:	08/23/2019
Last Update Date	:	09/22/2022

Similar Medicare Providers

1225129786 — MRS. MARIA BEATRIZ GIRALDO M.A. COUNSELING
Practice Location Address:

1437 VIEW VISTA PARK
PORT ANGELES, WA
98362-9356

Practice Phone: 360-461-5188
Practice Fax:

1992047161 — DR. DEBORAH P. MILLIKEN D.M.D.
Practice Location Address:

600 W COLLEGE DR , BLDG T-1
AVON PARK, FL
33825-9356

Practice Phone: 863-784-7023
Practice Fax: 863-784-7026

1376514455 — DR. JANICE L BENDING PHD
Practice Location Address:

2400 N CROATAN HWY STE F
KILL DEVIL HILLS, NC
27948-9356

Practice Phone: 252-489-8874
Practice Fax: 252-305-8247

1972876696 — DR. RAMUNE R. MACIEJAUSKAS-WATERS D.D.S.
Practice Location Address:

9356 S ROBERTS RD
HICKORY HILLS, IL
60457-2168

Practice Phone: 708-598-2131
Practice Fax:

1427529155 — WELLNESS WITHIN PROFESSIONAL COUNSELING
Practice Location Address:

2400 N CROATAN HWY STE F
KILL DEVIL HILLS, NC
27948-9356

Practice Phone: 252-339-4915
Practice Fax:

1063158525 — NICOLE SMITH
Practice Location Address:

2400 N CROATAN HWY STE G
KILL DEVIL HILLS, NC
27948-9356

Practice Phone: 252-207-9511
Practice Fax:

Directions to “GREAT MINES HEALTH CENTER ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.