BONNE TERRE HEALTH CLINIC LLC
NPI 1104071935
Clinic/Center - Rural Health in Bonne Terre, MO
NPI Status: Active since November 20, 2008
Contact Information
55 NESBIT DR
BONNE TERRE, MO
ZIP 63628
Phone: (573) 358-3343
Fax: (573) 358-5458
- Organization
- Clinic/Center
- Rural Health
- CLIA Number: 26D2178139
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 01-27-2028
About BONNE TERRE HEALTH CLINIC LLC
This page provides the complete NPI Profile along with additional information for Bonne Terre Health Clinic Llc, a primary care provider established in Bonne Terre, Missouri operating as a Clinic/center, focusing in rural health . The healthcare provider is registered in the NPI registry with number 1104071935 assigned on November 2008. The practitioner's primary taxonomy code is 261QR1300X with license number 102387 (MO). The provider is registered as an organization and their NPI record was last updated 17 years ago. The organization operates as a Single Specialty Group with one or more individual practitioners, all of who practice with the same area of specialization. The authorized official of this NPI record is Mr. Andrew John Ninichuck M.d. (Member)
- NPI
- 1104071935
- Provider Name
- BONNE TERRE HEALTH CLINIC LLC
- Entity Type
- Organization
- Location Address
- 55 NESBIT DR BONNE TERRE, MO 63628
- Location Phone
- (573) 358-3343
- Location Fax
- (573) 358-5458
- Mailing Address
- 55 NESBIT DR BONNE TERRE, MO 63628
- Mailing Phone
- (573) 358-3343
- Mailing Fax
- (573) 358-5458
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 11-20-2008
- Last Update Date
- 09-24-2009
- Code Navigator
A primary care provider (PCP) like Bonne Terre Health Clinic Llc sees people with common medical problems. The primary care provider might be a doctor, physician assistant, nurse practitioner or clinic that are usually involved in your long-term care. A PCP might provide preventive care, treat common medical conditions, identify urgent medical problems and refer you to specialists when necessary. Primary care is usually provided in an outpatient facility but if you are admitted to a hospital your PCP may assist in your care. The most common medical conditions seen by primary care providers are: hypertension, upper respiratory tract infections, depression or anxiety, back pain, arthritis, dermatitis, diabetes, urinary tract infections, etc .
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Clinic/Center Rural Health
- Taxonomy Code
- 261QR1300X
- Type
- Ambulatory Health Care Facilities
- License No.
- 102387
- License State
- MO
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | 102387 (MO) |
Group Taxonomy 193400000X SINGLE SPECIALTY GROUP
This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 26D2178139
- Facility Type
- Physician Office
- Certificate Effective Date
- January 28, 2026
- Certificate Expiration Date
- January 27, 2028
- Laboratory Director
- MARY E. CHANDLER
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Bonne Terre Health Clinic Llc to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1104071935, we treat the final digit (5) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 55. The final step is to find the difference between that total and the next multiple of ten (60 - 55 = 5).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 55 is 60. The difference is the calculated check digit.
Other Providers at the Same Location
The following 7 providers are registered at the same or a nearby location.
BONNE TERRE, MO 63628
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1104071935, enumerated as an "organization" on November 20, 2008.
The provider is located at 55 NESBIT DR BONNE TERRE, MO 63628 and the phone number is (573) 358-3343.
Clinic/Center with taxonomy code 261QR1300X and a focus in Rural Health.
