MEDICARE: MOBERLY HOSPITAL COMPANY LLC

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	282N00000X	General Acute Care Hospital	423-9	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	652700000	OTHER	CHAMPUS
2	114	OTHER	BCBS
3	103184	OTHER	UNITED HEALTHCARE
4	5020191	OTHER	PHP
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	006895400	OTHER	BLACK LUNG

General Provider Information

NPI Number	:	1770554305
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOBERLY HOSPITAL COMPANY LLC

Provider Business Mailing Address
First Line	:	PO BOX 60856
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63160-0856
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1515 UNION AVE
Second Line	:
City	:	MOBERLY
State	:	MO
Zip	:	65270-9407
Country	:	US
Telephone Number	:	660-263-8400
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR / DELEGATED OFFICIAL
Name	:	PAULA M LALOR
Credential	:
Telephone Number	:	629-215-3953

Provider Enumeration Date	:	01/31/2006
Last Update Date	:	04/16/2021

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Directions to “MOBERLY HOSPITAL COMPANY LLC ” Practice Location

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