Healthcare Provider Details

I. General information

NPI: 1023002805
Provider Name (Legal Business Name): BREECH REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 DEADRA DR
LEBANON MO
65536-4669
US

IV. Provider business mailing address

100 HOSPITAL DR
LEBANON MO
65536-9210
US

V. Phone/Fax

Practice location:
  • Phone: 417-588-9330
  • Fax: 417-588-0217
Mailing address:
  • Phone: 417-588-9330
  • Fax: 417-588-0217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number2003026558
License Number StateMO

VIII. Authorized Official

Name: MR. DAVID E. WILHITE
Title or Position: BOARD CHAIR
Credential:
Phone: 417-532-3177