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CANTON/LAGRANGE FAMILY PRACTICE
NPI 1063431575
Clinic/Center - Rural Health in Canton, MO

Active since July 18, 2006CLIA 26D0911257 · Waiver
1802 ELM ST, CANTON, MO 63435(573) 655-4891(573) 288-5361 Get Directions Write a Review

NPPES record last updated: May 25, 2021. Verified against the NPPES registry weekly; last sync: August 23, 2026.

About Canton/lagrange Family Practice NPPES

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

CANTON/LAGRANGE FAMILY PRACTICE (NPI 1063431575) is a healthcare organization registered as a rural health in Canton, Missouri and active in the NPI registry since July 2006. The organization holds a CLIA Waiver certificate valid through December 9, 2027 and lists Rob Gasaway, Vp Of Finance, as its authorized official.

NPPES Registry Identity

NPI1063431575
Entity TypeOrganization
Primary Taxonomy261QR1300X
Legal Business NameHANNIBAL REGIONAL HEALTHCARE SYSTEM, INC
Location Address1802 ELM STCanton, MO 63435-1694
Mailing Address6500 Hospital DrHannibal, MO 63401-6890 · (573) 221-3415
Phone(573) 655-4891
Fax(573) 288-5361
Organization SubpartYes
Authorized OfficialRob GasawayVp Of Finance · (573) 406-1608
Enumeration DateJuly 18, 2006
Last NPPES UpdateMay 25, 2021
NPPES CertifiedMay 25, 2021
✔ NPI 1063431575 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Rural HealthAmbulatory Health Care Facilities
Taxonomy Code261QR1300X
1802 ELM ST, Canton, MO 63435
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Other Names 1

Doing Business AsCanton/lagrange Family Practice

Other Identifiers 1

Medicaid590416004MO

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 26D0911257

Canton Lagrange Family Practice · Canton, MO
Active · expires Dec 9, 2027
CLIA Number26D0911257
Laboratory TypeRural Health Clinic
Certificate Effective DateDecember 10, 2025
Certificate Expiration DateDecember 9, 2027
Laboratory DirectorMichael B. Tentori
Laboratory Phone(573) 288-5360
Laboratory LocationCanton Lagrange Family Practice1802 Elm, Canton, MO 63435
CLIA data matches this NPI record on: Address Name
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.

MS. CONNIE MARIE DOCHTERMAN APRN,BC
Nurse Practitioner (Family)
1802 ELM ST, CANTON-LAGRANGE FAMILY PRACTICE
CANTON, MO 63435
Lewis County (573) 288-5360

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 Hannibal Regional Healthcare System, Inc's NPI number?

The NPI number for Hannibal Regional Healthcare System, Inc is 1063431575. It was assigned to this organization in the NPPES registry on July 18, 2006. The provider is doing business as Canton/Lagrange Family Practice.

Where is Hannibal Regional Healthcare System, Inc located?

Hannibal Regional Healthcare System, Inc is located at 1802 Elm St, Canton, MO 63435. The listed phone number is (573) 655-4891.

What is Hannibal Regional Healthcare System, Inc's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Rural Health, with taxonomy code 261QR1300X.

Does Hannibal Regional Healthcare System, Inc hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 26D0911257) is associated with this NPI, valid through December 9, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Hannibal Regional Healthcare System, Inc was last updated on May 25, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.