Healthcare Provider Details

I. General information

NPI: 1528067113
Provider Name (Legal Business Name): CARROLL COUNTY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2005
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
CARROLLTON MO
64633-1948
US

V. Phone/Fax

Practice location:
  • Phone: 660-542-1695
  • Fax: 660-542-0363
Mailing address:
  • Phone: 660-542-1695
  • Fax: 660-542-0363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number26Z332
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number210-45
License Number StateMO

VIII. Authorized Official

Name: AMY DANIELLE IRELAND
Title or Position: CFO
Credential:
Phone: 660-329-6005