Healthcare Provider Details

I. General information

NPI: 1811903966
Provider Name (Legal Business Name): JEFFERSON MEMORIAL HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 US HIGHWAY 61
FESTUS MO
63028-4100
US

IV. Provider business mailing address

PO BOX 350
CRYSTAL CITY MO
63019-0350
US

V. Phone/Fax

Practice location:
  • Phone: 636-933-1000
  • Fax:
Mailing address:
  • Phone: 636-933-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number160-48
License Number StateMO

VIII. Authorized Official

Name: MR. JAMES L MUEHLHAUSER
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 636-933-1103