Healthcare Provider Details

I. General information

NPI: 1699185843
Provider Name (Legal Business Name): FULTON MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2014
Last Update Date: 05/20/2020
Certification Date: 05/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 S HOSPITAL DR
FULTON MO
65251-2510
US

IV. Provider business mailing address

11221 ROE AVE SUITE 320
LEAWOOD KS
66211-1922
US

V. Phone/Fax

Practice location:
  • Phone: 573-642-3376
  • Fax: 573-642-9830
Mailing address:
  • Phone: 913-387-0510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: MR. DANIEL R TASSET
Title or Position: VICE CHAIR, NUEHEALTH
Credential:
Phone: 913-387-0510