Healthcare Provider Details

I. General information

NPI: 1104999762
Provider Name (Legal Business Name): MCCUNE-BROOKS HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 06/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3125 DR RUSSELL SMITH WAY
CARTHAGE MO
64836-7402
US

IV. Provider business mailing address

3125 DR RUSSELL SMITH WAY
CARTHAGE MO
64836-7402
US

V. Phone/Fax

Practice location:
  • Phone: 417-358-8121
  • Fax: 417-237-7240
Mailing address:
  • Phone: 417-358-8121
  • Fax: 417-237-7240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number23-48
License Number StateMO

VIII. Authorized Official

Name: MR. ROBERT Y COPELAND JR.
Title or Position: CEO
Credential:
Phone: 417-359-2655