Healthcare Provider Details

I. General information

NPI: 1457390114
Provider Name (Legal Business Name): MACON COUNTY SAMARITAN HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 05/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 N MISSOURI ST
MACON MO
63552-2095
US

IV. Provider business mailing address

1205 N MISSOURI ST
MACON MO
63552-2095
US

V. Phone/Fax

Practice location:
  • Phone: 660-385-8700
  • Fax: 660-385-8701
Mailing address:
  • Phone: 660-385-8700
  • Fax: 660-385-8701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SUSAN J SPENCER
Title or Position: CFO
Credential: CPA
Phone: 660-385-8716