Healthcare Provider Details

I. General information

NPI: 1508977844
Provider Name (Legal Business Name): CEDAR COUNTY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 02/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1317 S HWY 32
EL DORADO SPRINGS MO
64744-2302
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 417-876-5477
  • 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: MS. JANA WITT
Title or Position: CEO
Credential: CEO
Phone: 417-876-2511