MEDICARE: SCHUYLER COUNTY NURSING HOME DISTRICT

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	314000000X	Skilled Nursing Facility	031472	MO
2	314000000X	Skilled Nursing Facility	041379	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	26E193	OTHER	MO	FEDERAL ID (OSCAR)
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306906631
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCHUYLER COUNTY NURSING HOME DISTRICT

Provider Business Mailing Address
First Line	:	1306 US HIGHWAY 63
Second Line	:
City	:	QUEEN CITY
State	:	MO
Zip	:	63561-2251
Country	:	US
Telephone Number	:	660-766-2291
Fax Number	:	660-766-2884

Provider Business Practice Location Address
First Line	:	1306 US HIGHWAY 63
Second Line	:
City	:	QUEEN CITY
State	:	MO
Zip	:	63561-2251
Country	:	US
Telephone Number	:	660-766-2291
Fax Number	:	660-766-2884

Authorized Official
Title or Position	:	ASSISTANT ADMINISTRATOR
Name	:	MRS. MARCIA L MARTIN
Credential	:
Telephone Number	:	660-766-2291

Provider Enumeration Date	:	12/08/2006
Last Update Date	:	07/21/2022

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Directions to “SCHUYLER COUNTY NURSING HOME DISTRICT ” Practice Location

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