Healthcare Provider Details

I. General information

NPI: 1346215944
Provider Name (Legal Business Name): KIRKSVILLE MISSOURI HOSPITAL COMPANY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 04/28/2021
Certification Date: 04/28/2021
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 7972
BELFAST ME
04915-7900
US

V. Phone/Fax

Practice location:
  • Phone: 660-397-2400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number462-4
License Number StateMO

VIII. Authorized Official

Name: PAULA M LALOR
Title or Position: DIRECTOR/DELEGATED OFFICIAL
Credential:
Phone: 629-215-3953