Healthcare Provider Details

I. General information

NPI: 1508155888
Provider Name (Legal Business Name): HANNIBAL REGIONAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2011
Last Update Date: 04/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 NORTHPORT PLZ
HANNIBAL MO
63401-2269
US

IV. Provider business mailing address

PO BOX 1239 6500 HOSPITAL DRIVE
HANNIBAL MO
63401-1239
US

V. Phone/Fax

Practice location:
  • Phone: 573-221-2646
  • Fax: 573-221-4479
Mailing address:
  • Phone: 573-406-5888
  • Fax: 573-406-5889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROGER J DIX
Title or Position: CFO
Credential:
Phone: 573-248-1300