MEDICARE: TEXAS COUNTY MEMORIAL HOSPITAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	2012026256	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2614700	OTHER	MO	NCPDP
3	2136307	OTHER		PK

General Provider Information

NPI Number	:	1164587770
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXAS COUNTY MEMORIAL HOSPITAL

Provider Business Mailing Address
First Line	:	1422 S SAM HOUSTON BLVD STE 100
Second Line	:
City	:	HOUSTON
State	:	MO
Zip	:	65483-2130
Country	:	US
Telephone Number	:	417-967-4139
Fax Number	:	417-967-4130

Provider Business Practice Location Address
First Line	:	1422 S SAM HOUSTON BLVD STE 100
Second Line	:
City	:	HOUSTON
State	:	MO
Zip	:	65483
Country	:	US
Telephone Number	:	417-967-4139
Fax Number	:	417-967-4130

Authorized Official
Title or Position	:	CEO
Name	:	WESLEY MURRAY
Credential	:
Telephone Number	:	417-967-3311

Provider Enumeration Date	:	12/26/2006
Last Update Date	:	11/22/2019

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Directions to “TEXAS COUNTY MEMORIAL HOSPITAL ” Practice Location

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