Healthcare Provider Details

I. General information

NPI: 1558389189
Provider Name (Legal Business Name): HANNIBAL REGIONAL HEALTHCARE SYSTEM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 02/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 S 3RD ST
LOUISIANA MO
63353-2000
US

IV. Provider business mailing address

6000 HOSPITAL DR
HANNIBAL MO
63401-6887
US

V. Phone/Fax

Practice location:
  • Phone: 573-754-5555
  • Fax: 573-754-4077
Mailing address:
  • Phone: 573-248-1300
  • Fax:

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: ROGER J DIX
Title or Position: CFO
Credential:
Phone: 573-248-1300