Healthcare Provider Details

I. General information

NPI: 1891757191
Provider Name (Legal Business Name): SKAGGS COMMUNITY HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 01/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 BIRCH RD STE. 1C
HOLLISTER MO
65672-9607
US

IV. Provider business mailing address

590 BIRCH RD STE. 1C
HOLLISTER MO
65672-9605
US

V. Phone/Fax

Practice location:
  • Phone: 417-348-8500
  • Fax: 417-348-8510
Mailing address:
  • Phone: 417-348-8500
  • Fax: 417-348-8510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number919
License Number StateMO

VIII. Authorized Official

Name: WILLIAM K MAHONEY
Title or Position: CEO
Credential:
Phone: 417-335-7350