BOONE PHYSICIAN SERVICES, LLC
NPI 1619648532
Clinic/Center - Rural Health in Centralia, MO

Q: What is Boone Physician Services, LLC's NPI number?

The NPI number for Boone Physician Services, LLC is 1619648532. It was assigned to this organization in the NPPES registry on September 21, 2021. The provider is doing business as Centralia Family Health Clinic.

Q: What is Boone Physician Services, LLC's specialty?

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

Active since September 21, 2021

1021 E HIGHWAY 22, CENTRALIA, MO 65240(573) 682-5588(573) 682-1539 Get Directions Write a Review

NPPES record last updated: September 21, 2021. Verified against the NPPES registry weekly; last sync: October 25, 2026.

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About Boone Physician Services, Llc NPPES

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

BOONE PHYSICIAN SERVICES, LLC (NPI 1619648532), doing business as Centralia Family Health Clinic, is a healthcare organization registered as a rural health in Centralia, Missouri and active in the NPI registry since September 2021. The organization lists Brian Lee Winn, Director Of Finance, as its authorized official.

NPPES Registry Identity

NPI1619648532

Entity TypeOrganization

Primary Taxonomy261QR1300X

Legal Business NameBOONE PHYSICIAN SERVICES, LLC

Location Address1021 E HIGHWAY 22Centralia, MO 65240-1183

Mailing Address1021 E Highway 22Centralia, MO 65240-1183 · (573) 682-5588 · Fax (573) 682-1539

Phone(573) 682-5588

Fax(573) 682-1539

Organization SubpartNo

Authorized OfficialBrian Lee WinnDirector Of Finance · (573) 815-3269

Enumeration DateSeptember 21, 2021

NPPES CertifiedSeptember 3, 2021

✔ NPI 1619648532 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Rural HealthAmbulatory Health Care Facilities

Taxonomy Code261QR1300X

1021 E HIGHWAY 22, Centralia, MO 65240

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Other Names 1

Doing Business AsCentralia Family Health Clinic

Medicare Participation & PECOS CMS

Medicare enrollment and revalidation status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Boone Physician Services, Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Revalidation Due Date

Revalidation due by February 28, 2027

Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.

StateEnrollment IDDue date

StateMissouriEnrollment IDO20211004002355Part A · Rural Health ClinicDue dateFebruary 28, 2027

Source: CMS Revalidation Due Date List, October 2026 release.

Other Providers at the Same Location NPPES 7

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

REBECCA B KELLEY M.D.

Family Medicine