| New Madrid Medical Center | |
|
421 Semo Dr New Madrid MO 63869-1733 | |
| (573) 748-2592 | |
| (573) 748-2673 |
| Full Name | New Madrid Medical Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 421 Semo Dr, New Madrid, Missouri |
| Authorized Official Name and Position | Sara Deane (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 5733132500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| New Madrid Medical Center 6738 State Highway 77 Benton MO 63736-8238 Ph: (573) 313-2500 | New Madrid Medical Center 421 Semo Dr New Madrid MO 63869-1733 Ph: (573) 748-2592 |
| NPI Number | 1609095975 |
|---|---|
| Provider Enumeration Date | 04/25/2007 |
| Last Update Date | 04/14/2020 |
| Medicare PECOS PAC ID | 6507818044 |
|---|---|
| Medicare Enrollment ID | O20050412000011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609095975 | NPI | - | NPPES |
| 500704010 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
| Provider Name | William B Bradley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649375940 PECOS PAC ID: 3375595804 Enrollment ID: I20050214000184 |
| Provider Name | Judith Haggard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619088390 PECOS PAC ID: 6800838962 Enrollment ID: I20050531000058 |
| Provider Name | Nelson R Perez |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1043363005 PECOS PAC ID: 4880503424 Enrollment ID: I20051026000184 |
| Provider Name | Daniel G Domjan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1235119215 PECOS PAC ID: 8022907740 Enrollment ID: I20070730000112 |
| Provider Name | James G Sheridan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1154339752 PECOS PAC ID: 9032126206 Enrollment ID: I20130204000212 |
| Provider Name | Amanda Bader |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255696001 PECOS PAC ID: 8820245772 Enrollment ID: I20131202001557 |
| Provider Name | Micah Harris |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1679816433 PECOS PAC ID: 8123258936 Enrollment ID: I20140222000438 |
| Provider Name | Rebecca Vanessa Young |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457785123 PECOS PAC ID: 5890925341 Enrollment ID: I20140228000215 |
| Provider Name | Nathan S Sprengel |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1912260597 PECOS PAC ID: 2769620566 Enrollment ID: I20150819007004 |
| Provider Name | Delayna Hunter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639591506 PECOS PAC ID: 4082906631 Enrollment ID: I20160630000978 |
| Provider Name | Seth Tyler Koehler |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1255782843 PECOS PAC ID: 3577854108 Enrollment ID: I20181203000133 |
| Provider Name | Tia Heskett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487249306 PECOS PAC ID: 2860896479 Enrollment ID: I20210804001579 |
| Provider Name | Summer Ladawn Alexander |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740728187 PECOS PAC ID: 4082998299 Enrollment ID: I20220929002901 |
| Provider Name | Taylor Rae Altenthal |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811548530 PECOS PAC ID: 3577949361 Enrollment ID: I20220930002874 |
| Provider Name | Autumn Lynnette Allgood |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932824950 PECOS PAC ID: 9335516509 Enrollment ID: I20221031002204 |
| Provider Name | Sydney Justine Vangennip |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376252841 PECOS PAC ID: 2163892795 Enrollment ID: I20221223000058 |
| Provider Name | Amberly D Pritchard |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1225445653 PECOS PAC ID: 0345658837 Enrollment ID: I20231213001874 |
| Provider Name | Samantha Anne Duffel |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1760173421 PECOS PAC ID: 1456703487 Enrollment ID: I20240116001317 |
Mercy Hospital Stoddard Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 800 Us Highway 61, New Madrid, MO 63869 Phone: 573-521-2442 Fax: 573-624-8895 | |
Southeast Missouri Health Network Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 310 Us Highway 61, New Madrid, MO 63869 Phone: 573-688-2165 Fax: 573-313-2505 | |
Ferguson Medical Group Rural Health Center, Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 565 Virginia Ave, New Madrid, MO 63869 Phone: 573-471-0330 Fax: 573-481-5019 | |
Bootheel Primary Care New Madrid Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 555 Virginia Ave, New Madrid, MO 63869 Phone: 573-748-3107 Fax: 573-748-3112 | |
New Madrid Community Care Center Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 615 Main St, New Madrid, MO 63869 Phone: 573-748-2546 Fax: 573-748-7622 |