Healthcare Provider Details

I. General information

NPI: 1669606588
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: 08/15/2023
Certification Date: 08/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 W NURSERY ST
BUTLER MO
64730-1840
US

IV. Provider business mailing address

617 W NURSERY ST
BUTLER MO
64730-1840
US

V. Phone/Fax

Practice location:
  • Phone: 660-200-7133
  • Fax:
Mailing address:
  • Phone: 660-200-7133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number268606
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number109083
License Number StateMO

VIII. Authorized Official

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