Healthcare Provider Details

I. General information

NPI: 1477091890
Provider Name (Legal Business Name): PEMISCOT COUNTY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2017
Last Update Date: 02/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 E WASHINGTON ST
KENNETT MO
63857-2041
US

IV. Provider business mailing address

105 E. WASHINGTON
KENNETT MO
63857
US

V. Phone/Fax

Practice location:
  • Phone: 573-888-1137
  • Fax: 573-888-0920
Mailing address:
  • Phone: 573-888-1137
  • Fax: 573-888-0920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KERRY NOBLE
Title or Position: CEO
Credential:
Phone: 573-359-3612