Healthcare Provider Details

I. General information

NPI: 1972611218
Provider Name (Legal Business Name): PEMISCOT COUNTY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 09/27/2023
Certification Date: 09/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

946 E REED ST
HAYTI MO
63851-1243
US

IV. Provider business mailing address

P O BOX 489
HAYTI MO
63851
US

V. Phone/Fax

Practice location:
  • Phone: 573-359-1372
  • Fax:
Mailing address:
  • Phone: 573-359-1372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JOAN WHITE-WAGONER
Title or Position: CEO
Credential:
Phone: 573-359-3612