Healthcare Provider Details

I. General information

NPI: 1164688552
Provider Name (Legal Business Name): LANDMARK HOSPITAL OF CAPE GIRARDEAU, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2008
Last Update Date: 08/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3255 INDEPENDENCE ST
CAPE GIRARDEAU MO
63701-4914
US

IV. Provider business mailing address

3255 INDEPENDENCE ST
CAPE GIRARDEAU MO
63701-4914
US

V. Phone/Fax

Practice location:
  • Phone: 573-335-1091
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: DEBORAH SABELLA
Title or Position: CEO
Credential: RN
Phone: 573-331-8420