Healthcare Provider Details

I. General information

NPI: 1083154991
Provider Name (Legal Business Name): HANNIBAL REGIONAL HEALTHCARE SYSTEM,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2017
Last Update Date: 02/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3650 STARDUST DR
HANNIBAL MO
63401-2480
US

IV. Provider business mailing address

PO BOX 801222
KANSAS CITY MO
64180-1222
US

V. Phone/Fax

Practice location:
  • Phone: 573-231-0660
  • Fax: 573-231-0687
Mailing address:
  • Phone: 573-248-5672
  • Fax: 573-248-5448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROBERT GASAWAY
Title or Position: CFO
Credential:
Phone: 573-406-1609