Healthcare Provider Details

I. General information

NPI: 1275674699
Provider Name (Legal Business Name): SULLIVAN COUNTY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 04/24/2023
Certification Date: 04/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 W 3RD ST
MILAN MO
63556-1076
US

IV. Provider business mailing address

630 W 3RD ST
MILAN MO
63556-1076
US

V. Phone/Fax

Practice location:
  • Phone: 660-265-4212
  • Fax: 660-265-4898
Mailing address:
  • Phone: 660-265-4212
  • Fax: 660-265-4898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number130-49
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: AMY MICHAEL
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 660-265-4212