Healthcare Provider Details

I. General information

NPI: 1619090404
Provider Name (Legal Business Name): CEDAR COUNTY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 S PARK ST
EL DORADO SPRINGS MO
64744-2037
US

IV. Provider business mailing address

1401 S PARK ST
EL DORADO SPRINGS MO
64744-2037
US

V. Phone/Fax

Practice location:
  • Phone: 417-876-2511
  • Fax: 417-876-3812
Mailing address:
  • Phone: 417-876-2511
  • Fax: 417-876-3812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number State

VIII. Authorized Official

Name: CARLA C GILBERT
Title or Position: INTERIM CEO AND CFO
Credential:
Phone: 417-876-2511