NPI Record of MIDWEST DIVISION-LRHC, LLC NPI 1003872185

Clinic/Center (Rural Health) in Odessa, MO

Complete NPI Record


Field Name Value Definition
NPI1003872185National Provider Indentifier (NPI)
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code2Entity type code (type of health care provider assigned an NPI).
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EINUNAVAILProvider Employer Identification Number (EIN).
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
Provider Organization Name Legal Business NameMIDWEST DIVISION-LRHC, LLCProvider organization name.
The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider Other Organization NameODESSA MEDICAL GROUPProvider other last or other organization name.
Other name by which the organization provider is or has been known.
Provider Other Organization Name Type Code3Provider other organization name type code.
Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
Provider First Line Business Mailing Address1280 W US HIGHWAY 40Provider first line mailing address.
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address City NameODESSAProvider mailing address city name.
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State NameMOProvider mailing address State name.
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code640769612Provider mailing address postal code.
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S USProvider mailing address country code.
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number8166335774Provider mailing address telephone number.
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Business Mailing Address Fax Number8166335936Provider mailing address fax number.
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider First Line Business Practice Location Address1280 W US HIGHWAY 40Provider first line location address.
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City NameODESSAProvider location address city name.
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameMOProvider location address State code.
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code640769612Provider location address postal code.
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S USProvider location address country code.
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number8166335774Provider location address telephone number.
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number8166335936Provider location address fax number.
The fax number associated with the location address of the provider being identified.
Provider Enumeration Date4/26/2006Provider enumeration date.
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date3/10/2016Last update date.
The date that a record was last updated or changed.
Authorized Official Last NameBOXAuthorized official last name.
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First NameDARRELAuthorized official first name.
The first name of the authorized official.
Authorized Official Title or PositionCEO LRHCAuthorized official title or position.
The title or position of the authorized official.
Authorized Official Telephone Number6602596852Authorized official telephone number.
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1261QR1300XProvider taxonomy code.
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 1Y
Other Provider Identifier 1595985805Other provider identifier.
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 105Other provider identifier type code.
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 1MO
Other Provider Identifier 2540568508Other provider identifier.
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 205Other provider identifier type code.
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 2MO
Other Provider Identifier 3010568509Other provider identifier.
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 305Other provider identifier type code.
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 3MO
Is Organization SubpartN