Healthcare Provider Details

I. General information

NPI: 1164451746
Provider Name (Legal Business Name): FREEMAN NEOSHO HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 10/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 W HICKORY ST
NEOSHO MO
64850-1705
US

IV. Provider business mailing address

PO BOX 3930
JOPLIN MO
64803-3930
US

V. Phone/Fax

Practice location:
  • Phone: 417-347-1078
  • Fax: 417-347-1079
Mailing address:
  • Phone: 417-347-1078
  • Fax: 417-347-1079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JOE L. KIRK
Title or Position: EXECUTIVE VP
Credential:
Phone: 417-347-1111