MEDICARE: PHELPS COUNTY REGIONAL MEDICAL CENTER

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	261QR1300X	Rural Health Clinic/Center

General Provider Information

NPI Number	:	1194077701
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHELPS COUNTY REGIONAL MEDICAL CENTER

Provider Business Mailing Address
First Line	:	PO BOX 579
Second Line	:
City	:	ROLLA
State	:	MO
Zip	:	65402-0579
Country	:	US
Telephone Number	:	573-426-2182
Fax Number	:	573-426-5341

Provider Business Practice Location Address
First Line	:	1415 W SCENIC RIVERS BLVD
Second Line	:
City	:	SALEM
State	:	MO
Zip	:	65560-2840
Country	:	US
Telephone Number	:	573-729-5533
Fax Number	:	573-202-2466

Authorized Official
Title or Position	:	CFO/SR VP
Name	:	JANA MARIE COOK
Credential	:
Telephone Number	:	573-458-7916

Provider Enumeration Date	:	10/05/2012
Last Update Date	:	02/02/2023

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