Healthcare Provider Details

I. General information

NPI: 1578797494
Provider Name (Legal Business Name): BATES COUNTY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2009
Last Update Date: 11/05/2021
Certification Date: 11/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 E. MAIN
ADRIAN MO
64720
US

IV. Provider business mailing address

102 E MAIN ST.
ADRIAN MO
64720
US

V. Phone/Fax

Practice location:
  • Phone: 816-297-2640
  • Fax: 660-200-7015
Mailing address:
  • Phone: 816-297-2640
  • Fax: 660-200-7015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2006007886
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateMO

VIII. Authorized Official

Name: GREGORY WEAVER
Title or Position: CEO
Credential:
Phone: 660-200-7000