Healthcare Provider Details

I. General information

NPI: 1164776944
Provider Name (Legal Business Name): KIRKSVILLE MISSOURI HOSPITAL COMPANY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2012
Last Update Date: 12/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 S 5TH ST
EDINA MO
63537-1526
US

IV. Provider business mailing address

PO BOX 689022
FRANKLIN TN
37068-9022
US

V. Phone/Fax

Practice location:
  • Phone: 660-397-2100
  • Fax: 660-297-3292
Mailing address:
  • Phone: 615-465-3000
  • Fax: 615-465-3007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateMO

VIII. Authorized Official

Name: BRIAN PEOPLES
Title or Position: VICE-PRESIDENT
Credential:
Phone: 615-465-7585