Healthcare Provider Details

I. General information

NPI: 1346212784
Provider Name (Legal Business Name): MOBERLY HOSPITAL COMPANY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 04/16/2021
Certification Date: 04/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 UNION AVE
MOBERLY MO
65270-9407
US

IV. Provider business mailing address

PO BOX 60856
SAINT LOUIS MO
63160-0856
US

V. Phone/Fax

Practice location:
  • Phone: 660-263-8400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number423-9
License Number StateMO

VIII. Authorized Official

Name: PAULA M LALOR
Title or Position: DIRECTOR/DELEGATED OFFICIAL
Credential:
Phone: 629-215-3953