Healthcare Provider Details

I. General information

NPI: 1124074430
Provider Name (Legal Business Name): DREW COUNTY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 10/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

778 SCOGIN DRIVE
MONTICELLO AR
71655-5729
US

IV. Provider business mailing address

400 EAST 10TH STREET
WACONIA MN
55387-4552
US

V. Phone/Fax

Practice location:
  • Phone: 870-367-2411
  • Fax: 952-442-3620
Mailing address:
  • Phone: 952-442-9770
  • Fax: 952-442-3620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: SHANNON R CLARK
Title or Position: CFO
Credential:
Phone: 870-460-3599