Healthcare Provider Details

I. General information

NPI: 1922356765
Provider Name (Legal Business Name): HANNIBAL REGIONAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2012
Last Update Date: 08/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 MEDICAL PARK DR
MEXICO MO
65265-3726
US

IV. Provider business mailing address

PO BOX 1239
HANNIBAL MO
63401-1239
US

V. Phone/Fax

Practice location:
  • Phone: 573-581-7196
  • Fax: 573-581-3632
Mailing address:
  • Phone: 573-406-5888
  • Fax: 573-406-5889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ROGER DIX
Title or Position: VP FINANCE
Credential:
Phone: 573-406-1609