Healthcare Provider Details

I. General information

NPI: 1487807657
Provider Name (Legal Business Name): COOPER COUNTY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2008
Last Update Date: 10/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17651 B HWY
BOONVILLE MO
65233-2839
US

IV. Provider business mailing address

17651 B HWY
BOONVILLE MO
65233-2839
US

V. Phone/Fax

Practice location:
  • Phone: 660-882-7461
  • Fax: 660-882-6093
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number24836
License Number StateMO

VIII. Authorized Official

Name: BRENDA CAMPBELL
Title or Position: CFO
Credential:
Phone: 660-882-7461