Healthcare Provider Details

I. General information

NPI: 1568092732
Provider Name (Legal Business Name): SCOTLAND COUNTY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2020
Last Update Date: 01/16/2020
Certification Date: 01/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55682 STATE HIGHWAY 6
EDINA MO
63537-4267
US

IV. Provider business mailing address

55682 STATE HIGHWAY 6
EDINA MO
63537-4267
US

V. Phone/Fax

Practice location:
  • Phone: 660-465-8513
  • Fax: 660-465-2956
Mailing address:
  • Phone: 660-465-8513
  • Fax: 660-465-2956

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: SHERYL SMITH-TEMPLETON
Title or Position: CFO
Credential:
Phone: 660-465-8513