Healthcare Provider Details

I. General information

NPI: 1154645745
Provider Name (Legal Business Name): HARRISON COUNTY COMMUNITY HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2010
Last Update Date: 09/21/2021
Certification Date: 09/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3202 MILLER ST
BETHANY MO
64424-2713
US

IV. Provider business mailing address

3202 MILLER ST
BETHANY MO
64424-2713
US

V. Phone/Fax

Practice location:
  • Phone: 660-425-3154
  • Fax: 660-425-6663
Mailing address:
  • Phone: 660-425-3154
  • Fax: 660-425-6663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CHRISTINA GILLESPIE
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 660-425-2211