MEDICARE: HANNIBAL REGIONAL 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	261QM0855X	Adolescent and Children Mental Health Clinic/Center
2	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1225382435
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HANNIBAL REGIONAL HOSPITAL

Provider Business Mailing Address
First Line	:	6500 HOSPITAL DR
Second Line	:	P O BOX 1239
City	:	HANNIBAL
State	:	MO
Zip	:	63401-6890
Country	:	US
Telephone Number	:	573-629-3370
Fax Number	:	573-406-5750

Provider Business Practice Location Address
First Line	:	3145 HIGHWAY 61
Second Line	:	SUITE A
City	:	HANNIBAL
State	:	MO
Zip	:	63401-6588
Country	:	US
Telephone Number	:	573-629-3370
Fax Number	:	573-406-5750

Authorized Official
Title or Position	:	VP FINANCE
Name	:	ROGER DIX
Credential	:
Telephone Number	:	573-629-1609

Provider Enumeration Date	:	11/09/2012
Last Update Date	:	11/09/2012

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Directions to “HANNIBAL REGIONAL HOSPITAL ” Practice Location

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