Healthcare Provider Details

I. General information

NPI: 1427350594
Provider Name (Legal Business Name): DEXTER HOSPITAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2010
Last Update Date: 11/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 W BUS HWY 60
DEXTER MO
63841
US

IV. Provider business mailing address

1300 N ONE MILE RD PO BOX 368
DEXTER MO
63841-1042
US

V. Phone/Fax

Practice location:
  • Phone: 573-624-7575
  • Fax: 573-624-6399
Mailing address:
  • Phone: 573-624-2171
  • Fax: 573-624-3157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. SUEANN WILLIAMS
Title or Position: CLINIC ADMINISTRATOR
Credential:
Phone: 573-624-1640