FORDLAND CLINIC INC. NPI 1639421365

NPI Information

NPI: 1639421365
Provider Name: FORDLAND CLINIC, INC.

Doing Business As: TRI-LAKES COMMUNITY HEALTH CENTER

Classification: Clinic/Center - 261QF0400X
Entity Type: Organization

Specialization: Federally Qualified Health Center (FQHC)

Address:
11863 STATE HIGHWAY 13
KIMBERLING CITY, MO
ZIP 65686
Phone: (417) 739-1995
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FORDLAND CLINIC, INC. is a federally qualified health center (fqhc) clinic center in Kimberling City, MO. FORDLAND CLINIC, INC. NPI is 1639421365. The provider is registered as an organization entity type.
The provider Is Doing Business As Tri-lakes Community Health Center.

The provider's business location address is:

11863 STATE HIGHWAY 13
KIMBERLING CITY, MO
ZIP 65686
Phone: (417) 739-1995

The provider's authorized official is Robert Marsh .
The authorized official title is Executive Director and has the following contact phone number (417) 767-2273.

The CLIA number assigned to this NPI record is 26D0916330 - federally qualified health center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/4/2012 and was last updated on 2/1/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QF0400X	Clinic/Center	Federally Qualified Health Center (FQHC)	26-1102	MISSOURI	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	261102	MEDICARE OSCAR/CERTIFICATION	MISSOURI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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