Healthcare Provider Details

I. General information

NPI: 1134311392
Provider Name (Legal Business Name): HANNIBAL REGIONAL HEALTHCARE SYSTEM, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2007
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 HOSPITAL DRIVE
HANNIBAL MO
63401-1239
US

IV. Provider business mailing address

PO BOX 1239
HANNIBAL MO
63401-1239
US

V. Phone/Fax

Practice location:
  • Phone: 573-248-1300
  • Fax: 573-248-5448
Mailing address:
  • Phone: 573-248-1300
  • Fax: 573-248-5448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number State

VIII. Authorized Official

Name: ROB GASAWAY
Title or Position: VP OF FINANCE
Credential:
Phone: 573-406-1608