FCC PRIMARY CARE CLINIC POPLAR BLUFF
NPI 1215510490
Internal Medicine in Poplar Bluff, MO

Q: What is Fcc Medical Clinics LLC's NPI number?

The NPI number for Fcc Medical Clinics LLC is 1215510490. It was assigned to this organization in the NPPES registry on May 4, 2021. The provider is doing business as Fcc Primary Care Clinic Poplar Bluff.

Q: What is Fcc Medical Clinics LLC's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Active since May 04, 2021CLIA 26D2164008 · Waiver

3001 WARRIOR LN, POPLAR BLUFF, MO 63901(573) 686-1200(573) 778-9492 Get Directions Write a Review

NPPES record last updated: July 12, 2021. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jul 12, 2021, May 4, 2021 (2 updates tracked since 2021).

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About Fcc Primary Care Clinic Poplar Bluff NPPES

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

FCC PRIMARY CARE CLINIC POPLAR BLUFF (NPI 1215510490) is a healthcare organization registered as an internal medicine in Poplar Bluff, Missouri and active in the NPI registry since May 2021. The organization holds a CLIA Waiver certificate valid through November 27, 2027 and lists Tracy Ellis, Cco, as its authorized official.

NPPES Registry Identity

NPI1215510490

Entity TypeOrganization

Primary Taxonomy207R00000X

Legal Business NameFCC MEDICAL CLINICS LLC

Location Address3001 WARRIOR LNPoplar Bluff, MO 63901-8685

Mailing AddressPo Box 71Kennett, MO 63857-0071

Phone(573) 686-1200

Fax(573) 778-9492

Organization SubpartYesParent: Family Counseling Center, Inc.

Authorized OfficialTracy EllisCco · (573) 888-5925

Enumeration DateMay 4, 2021

Last NPPES UpdateJuly 12, 20212 updates tracked since enumeration

NPPES CertifiedJuly 12, 2021

✔ NPI 1215510490 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207R00000X

Definition

A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.

Also ListedClinic/CenterTaxonomy 261Q00000X

3001 WARRIOR LN, Poplar Bluff, MO 63901

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Other Names 1

Doing Business AsFcc Primary Care Clinic Poplar Bluff

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

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arkansas Health & Wellness, Ambetter from Home State Health, Ambetter from Sunflower Health Plan and more.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 26D2164008

Fcc Primary Care Clinic · Kennett, MO

Active · expires Nov 27, 2027

CLIA Number26D2164008

Laboratory TypeRural Health Clinic

Certificate Effective DateNovember 28, 2025

Certificate Expiration DateNovember 27, 2027

Laboratory DirectorSarfaraz Jasdanwala

Laboratory Phone(573) 559-2365

Laboratory LocationFcc Primary Care Clinic900 State Route Vv, Kennett, MO 63857

CLIA data matches this NPI record on: Name

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 20

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

ALLYSON RAE FITZWATER

Community Health Worker