| Community Health Ctr Of Central Missouri | |
|
316 West Main Street Linn MO 65051 | |
| (573) 897-4946 | |
| (573) 897-4941 |
| Full Name | Community Health Ctr Of Central Missouri |
|---|---|
| Speciality | Clinic/Center |
| Location | 316 West Main Street, Linn, Missouri |
| Authorized Official Name and Position | Toby Barnett (CHIEF FIN OFFICER) |
| Authorized Official Contact | 5736320243 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Community Health Ctr Of Central Missouri P.o. Box 104780 Jefferson City MO 65110-4780 Ph: (573) 632-0243 | Community Health Ctr Of Central Missouri 316 West Main Street Linn MO 65051 Ph: (573) 897-4946 |
| NPI Number | 1538213244 |
|---|---|
| Provider Enumeration Date | 01/22/2007 |
| Last Update Date | 05/19/2023 |
| Medicare PECOS PAC ID | 2062456015 |
|---|---|
| Medicare Enrollment ID | O20050610000717 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538213244 | NPI | - | NPPES |
| 507340115 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
| Provider Name | Serese Y Smith-haxton |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1518048735 PECOS PAC ID: 8022919273 Enrollment ID: I20040120000302 |
| Provider Name | Daniel L Gibson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1699748772 PECOS PAC ID: 1850287103 Enrollment ID: I20040224001214 |
| Provider Name | Richard E Daugherty |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1760426878 PECOS PAC ID: 4688640105 Enrollment ID: I20040907000828 |
| Provider Name | Sheila Carnett |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1811902638 PECOS PAC ID: 9436153699 Enrollment ID: I20081030000295 |
| Provider Name | Shelly Lynn Gudehus |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629043849 PECOS PAC ID: 6103843396 Enrollment ID: I20100120000703 |
| Provider Name | Teri A Deffenbaugh |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1427006071 PECOS PAC ID: 1355472515 Enrollment ID: I20100701000698 |
| Provider Name | Brandi M Nichols |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1578656674 PECOS PAC ID: 3971637240 Enrollment ID: I20100823000708 |
| Provider Name | Crystal L Sullivan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1477864502 PECOS PAC ID: 8921123639 Enrollment ID: I20100918000172 |
| Provider Name | Adam C Patterson |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1912013582 PECOS PAC ID: 2365620945 Enrollment ID: I20110630000102 |
| Provider Name | Crystal L Cook |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1285897827 PECOS PAC ID: 5092984138 Enrollment ID: I20110808000318 |
| Provider Name | Amanda T Rodemann |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1265639603 PECOS PAC ID: 3476722182 Enrollment ID: I20110815000880 |
| Provider Name | Jodi A Berendzen |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1356509871 PECOS PAC ID: 7810169133 Enrollment ID: I20111011000253 |
| Provider Name | Sharon K Batek |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1962501353 PECOS PAC ID: 7618099730 Enrollment ID: I20120114000012 |
| Provider Name | Megan C King |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1649597667 PECOS PAC ID: 5597994442 Enrollment ID: I20140219000363 |
| Provider Name | Gaurav Ashok Kulkarni |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1962714162 PECOS PAC ID: 9335374842 Enrollment ID: I20150707000887 |
| Provider Name | Morgan Schiermeier |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1841552700 PECOS PAC ID: 9931343548 Enrollment ID: I20150811004704 |
| Provider Name | Jamie Brianne Luetkemeyer |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1386906899 PECOS PAC ID: 6901040500 Enrollment ID: I20150818004744 |
| Provider Name | Craig Luetkemeyer |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1013279967 PECOS PAC ID: 5597909101 Enrollment ID: I20150818005630 |
| Provider Name | April L Miller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356836266 PECOS PAC ID: 7113273855 Enrollment ID: I20180710003378 |
| Provider Name | Rebecca Lynn Hogg |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1316387814 PECOS PAC ID: 0648404764 Enrollment ID: I20181110000288 |
| Provider Name | Vivian Kamara |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568930154 PECOS PAC ID: 8426302829 Enrollment ID: I20181124000072 |
| Provider Name | Sheryl Cade |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649832833 PECOS PAC ID: 8325377153 Enrollment ID: I20190904001877 |
| Provider Name | Abigail Aguilar |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861032732 PECOS PAC ID: 0042646499 Enrollment ID: I20200204001358 |
| Provider Name | Jennifer Thomas |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1477072395 PECOS PAC ID: 0143645721 Enrollment ID: I20200729002652 |
| Provider Name | Jared James |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1386176840 PECOS PAC ID: 4688946023 Enrollment ID: I20200909002749 |
| Provider Name | Erica White |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053081752 PECOS PAC ID: 3173912821 Enrollment ID: I20211118000158 |
| Provider Name | Kimberly R Foster |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1508559006 PECOS PAC ID: 3779935101 Enrollment ID: I20240122000754 |
| Provider Name | Kerrie Dee Blair |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1952624272 PECOS PAC ID: 8325491517 Enrollment ID: I20240124000799 |
| Provider Name | Kristine Wall |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1275380628 PECOS PAC ID: 5294277166 Enrollment ID: I20240606002330 |
| Provider Name | John Michael Rockett |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1518584937 PECOS PAC ID: 3072918978 Enrollment ID: I20240905000224 |
Jefferson City Medical Group, P.c. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1306 E Main St, Linn, MO 65051 Phone: 573-897-2202 Fax: 573-897-3157 |