CENTRAL MISSOURI DERMATOLOGY ASSOC
NPI 1699663849
Clinic/Center - Medical Specialty in Columbia, MO

Q: What is the provider's specialty?

The provider's specialty is Clinic/Center with taxonomy code 261QM2500X and a focus in Medical Specialty.

Active since June 26, 2025CLIA 26D0949496 · Certificate of Compliance

401 N KEENE ST, COLUMBIA, MO 65201(573) 876-1616(573) 876-1678 Get Directions Write a Review

NPPES record last updated: June 26, 2025. Verified against the NPPES registry weekly; last sync: July 19, 2026.

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About Central Missouri Dermatology Assoc NPPES

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

CENTRAL MISSOURI DERMATOLOGY ASSOC (NPI 1699663849) is a healthcare organization registered as a medical specialty in Columbia, Missouri and active in the NPI registry since June 2025. The organization holds a CLIA Certificate of Compliance certificate valid through September 14, 2026 and lists Tiffany Martin, Billing Manager, as its authorized official.

NPPES Registry Identity

NPI1699663849

Entity TypeOrganization

Primary Taxonomy261QM2500X

Legal Business NameCENTRAL MISSOURI DERMATOLOGY ASSOC

Location Address401 N KEENE STColumbia, MO 65201-6625

Mailing Address401 N Keene StColumbia, MO 65201-6625 · (573) 876-1616 · Fax (573) 876-1678

Phone(573) 876-1616

Fax(573) 876-1678

Organization SubpartNo

Authorized OfficialTiffany MartinBilling Manager · (573) 876-1616

Enumeration DateJune 26, 2025

NPPES CertifiedJune 26, 2025

✔ NPI 1699663849 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Medical SpecialtyAmbulatory Health Care Facilities

Taxonomy Code261QM2500X

Definition

An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer).

401 N KEENE ST, Columbia, MO 65201

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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: 26D0949496
Facility Type: Physician Office
Certificate Effective Date: September 15, 2024
Certificate Expiration Date: September 14, 2026
Laboratory Director: ANDREW BASNETT
Certificate Type: Certificate of Compliance
Certificate Type Description: This CLIA certificate is issued to Central Missouri Dermatology Assoc after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements. This type of certificate is issued to laboratories that perform nonwaived (moderate and/or high complexity) testing.

Other Providers at the Same Location

The following 20 providers are registered at the same or a nearby location.

LINDA W. HANCIK APRN, BC, FNP

Nurse Practitioner (Family)

401 N KEENE ST, DR. LINDALL PERRY, BOONE CLINIC
COLUMBIA, MO 65201

Boone County (573) 874-3300

LISA D. MONSEES M.D.

Pediatrics (Adolescent Medicine)