Healthcare Provider Details

I. General information

NPI: 1063758118
Provider Name (Legal Business Name): ADVANCE HANNIBAL REGIONAL HOSPITAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2012
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 BUS HWY 24 WEST
MONROE CITY MO
63456
US

IV. Provider business mailing address

160 PROGRESS RD STE 111
HANNIBAL MO
63401-6630
US

V. Phone/Fax

Practice location:
  • Phone: 573-735-4113
  • Fax: 573-221-1808
Mailing address:
  • Phone: 573-735-4113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. GREGORY REIS
Title or Position: PARTNER
Credential: P.T
Phone: 217-222-6800