Healthcare Provider Details

I. General information

NPI: 1104129733
Provider Name (Legal Business Name): BARTON COUNTY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2010
Last Update Date: 03/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 W 2ND ST
LAMAR MO
64759-1029
US

IV. Provider business mailing address

102 W 2ND ST
LAMAR MO
64759-1029
US

V. Phone/Fax

Practice location:
  • Phone: 417-681-0214
  • Fax: 417-681-0136
Mailing address:
  • Phone: 417-681-0214
  • Fax: 417-681-0136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR8N54
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. TJ ALLEN
Title or Position: CLINIC BUSINESS COORDINATOR
Credential:
Phone: 417-681-0214