Healthcare Provider Details

I. General information

NPI: 1740726165
Provider Name (Legal Business Name): COMMUNITY HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2017
Last Update Date: 10/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 W MAIN ST
BURLINGTON JUNCTION MO
64428-7249
US

IV. Provider business mailing address

26136 US HIGHWAY 59
FAIRFAX MO
64446-9105
US

V. Phone/Fax

Practice location:
  • Phone: 660-725-3365
  • Fax: 660-725-3367
Mailing address:
  • Phone: 660-686-2328
  • Fax: 660-686-2618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number102-59
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JULIE JONES
Title or Position: CEO
Credential:
Phone: 660-686-2321