Healthcare Provider Details

I. General information

NPI: 1205831013
Provider Name (Legal Business Name): CARROLL COUNTY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 10/29/2021
Certification Date: 10/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1502 N JEFFERSON ST
CARROLLTON MO
64633-1948
US

IV. Provider business mailing address

1502 N JEFFERSON ST
CARROLLTON MO
64633-1948
US

V. Phone/Fax

Practice location:
  • Phone: 660-542-3301
  • Fax: 660-542-1691
Mailing address:
  • Phone: 660-542-3301
  • Fax: 660-542-1691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: AMY IRELAND
Title or Position: CHIEF REVENUE OFFICER
Credential:
Phone: 660-542-1695