Healthcare Provider Details

I. General information

NPI: 1225382435
Provider Name (Legal Business Name): HANNIBAL REGIONAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2012
Last Update Date: 11/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3145 HIGHWAY 61 SUITE A
HANNIBAL MO
63401-6588
US

IV. Provider business mailing address

6500 HOSPITAL DR P O BOX 1239
HANNIBAL MO
63401-6890
US

V. Phone/Fax

Practice location:
  • Phone: 573-629-3370
  • Fax: 573-406-5750
Mailing address:
  • Phone: 573-629-3370
  • Fax: 573-406-5750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROGER DIX
Title or Position: VP FINANCE
Credential:
Phone: 573-629-1609