Healthcare Provider Details

I. General information

NPI: 1972633410
Provider Name (Legal Business Name): LANDMARK HOSPITAL OF JOPLIN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 W. 32ND STREET
JOPLIN MO
64804
US

IV. Provider business mailing address

3255 INDEPENDENCE ST
CAPE GIRARDEAU MO
63701-4914
US

V. Phone/Fax

Practice location:
  • Phone: 417-627-1300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number503-0
License Number StateMO

VIII. Authorized Official

Name: TRACY LYNNE LAROSE
Title or Position: CFO
Credential: CPA
Phone: 573-450-2530