NORTHEAST MISSOURI PEDIATRIC CLINIC
NPI 1053457069
Pediatrics in Kirksville, MO

Active since January 29, 2007CLIA 26D1017986 · Waiver
600 W. JEFFERSON, KIRKSVILLE, MO 63501(660) 627-2229(660) 627-2233 Get Directions Write a Review

NPPES record last updated: April 1, 2009. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Northeast Missouri Pediatric Clinic NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

NORTHEAST MISSOURI PEDIATRIC CLINIC (NPI 1053457069) is a healthcare organization registered as a pediatrics in Kirksville, Missouri and active in the NPI registry since January 2007. The organization holds a CLIA Waiver certificate valid through June 20, 2028 and lists Andrew H. Grimm, Executive Director, as its authorized official.

NPPES Registry Identity

NPI1053457069
Entity TypeOrganization
Primary Taxonomy208000000X
Legal Business NameNORTHEAST MISSOURI HEALTH COUNCIL INC
Location Address600 W. JEFFERSONKirksville, MO 63501-2819
Mailing Address314 E Mcpherson StKirksville, MO 63501-3557 · (660) 627-5757 · Fax (660) 627-5802
Fax(660) 627-2233
Organization SubpartNo
Authorized OfficialAndrew H. GrimmExecutive Director · (660) 627-5757
Enumeration DateJanuary 29, 2007
Last NPPES UpdateApril 1, 2009
NPI 1053457069 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians
Taxonomy Code208000000X
Licenses Licensed in MO · 2005037590 Licensed in MO · 2006022612
Definition

A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.

600 W. JEFFERSON, Kirksville, MO 63501

Other Names 1

Doing Business AsNortheast Missouri Pediatric Clinic

Other Identifiers 3

Medicaid503351801MO
Medicare PIN000011740
Medicare OSCAR/certification261811

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 26D1017986

Northeast Missouri Pediatrics · Kirksville, MO
Active · expires Jun 20, 2028
CLIA Number26D1017986
Laboratory TypeFederally Qualified Health Center
Certificate Effective DateJune 21, 2026
Certificate Expiration DateJune 20, 2028
Laboratory DirectorRoxana Ionas, MD
Laboratory Phone(660) 627-2229
Laboratory LocationNortheast Missouri Pediatrics402 West Jefferson, Suite A, Kirksville, MO 63501
CLIA data matches this NPI record on: Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Family Medicine
600 W. JEFFERSON
KIRKSVILLE, MO 63501

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Northeast Missouri Health Council Inc's NPI number?

The NPI number for Northeast Missouri Health Council Inc is 1053457069. It was assigned to this organization in the NPPES registry on January 29, 2007. The provider is doing business as Northeast Missouri Pediatric Clinic.

Where is Northeast Missouri Health Council Inc located?

Northeast Missouri Health Council Inc is located at 600 W. Jefferson, Kirksville, MO 63501. The listed phone number is (660) 627-2229.

What is Northeast Missouri Health Council Inc's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

Does Northeast Missouri Health Council Inc hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 26D1017986) is associated with this NPI, valid through June 20, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Northeast Missouri Health Council Inc accept?

Health plans from Florida Blue (BlueCross BlueShield FL) and Florida Blue HMO (a BlueCross BlueShield FL company) list Northeast Missouri Health Council Inc as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Northeast Missouri Health Council Inc was last updated on April 1, 2009. NPI Profile syncs with the weekly NPPES data releases published by CMS.