Healthcare Provider Details

I. General information

NPI: 1437265311
Provider Name (Legal Business Name): PIKE COUNTY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 04/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2305 GEORGIA ST
LOUISIANA MO
63353-2559
US

IV. Provider business mailing address

2305 GEORGIA ST
LOUISIANA MO
63353-2559
US

V. Phone/Fax

Practice location:
  • Phone: 573-754-4584
  • Fax: 573-754-5280
Mailing address:
  • Phone: 573-754-4584
  • Fax: 573-754-5280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JUSTIN SELLE
Title or Position: CEO
Credential:
Phone: 573-754-5531