Healthcare Provider Details

I. General information

NPI: 1275730160
Provider Name (Legal Business Name): BARTON COUNTY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 05/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 NW 1ST LN
LAMAR MO
64759-8105
US

IV. Provider business mailing address

29 NW 1ST LN
LAMAR MO
64759-8105
US

V. Phone/Fax

Practice location:
  • Phone: 417-681-5284
  • Fax: 417-681-5514
Mailing address:
  • Phone: 417-681-5284
  • Fax: 417-681-5514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number101370
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberR3B59
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number114482
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number105928
License Number StateMO
# 5
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number106158
License Number StateMO
# 6
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number100303
License Number StateMO
# 7
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF0497088
License Number StateMO
# 8
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number268648
License Number StateMO

VIII. Authorized Official

Name: T J KILLINGSWORTH
Title or Position: BILLING OFFICE SUPERVISOR
Credential:
Phone: 417-681-5248