Healthcare Provider Details

I. General information

NPI: 1437221074
Provider Name (Legal Business Name): CEDAR COUNTY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 12/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1317 S. HIGHWAY 32
EL DORADO SPRINGS MO
64744
US

IV. Provider business mailing address

1317 S HIGHWAY 32
EL DORADO SPRINGS MO
64744
US

V. Phone/Fax

Practice location:
  • Phone: 417-876-5477
  • Fax: 417-876-5017
Mailing address:
  • Phone: 417-876-5477
  • Fax: 417-876-5017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number236-20
License Number StateMO

VIII. Authorized Official

Name: MRS. JANA C WITT
Title or Position: CEO
Credential:
Phone: 417-876-2511