Healthcare Provider Details

I. General information

NPI: 1972732378
Provider Name (Legal Business Name): LANDMARK HOSPITAL OF COLUMBIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2009
Last Update Date: 03/01/2024
Certification Date: 03/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 OLD HIGHWAY 63 N
COLUMBIA MO
65201-6308
US

IV. Provider business mailing address

3255 INDEPENDENCE ST
CAPE GIRARDEAU MO
63701-4914
US

V. Phone/Fax

Practice location:
  • Phone: 573-499-6600
  • Fax:
Mailing address:
  • Phone: 573-335-8457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number517-4
License Number StateMO

VIII. Authorized Official

Name: TRACY LYNNE BOLLINGER
Title or Position: CFO
Credential: CPA
Phone: 573-450-2530