Healthcare Provider Details

I. General information

NPI: 1295970945
Provider Name (Legal Business Name): COMMUNITY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2008
Last Update Date: 01/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 GIESLER DR
OSCEOLA MO
64776-6297
US

IV. Provider business mailing address

PO BOX 570
OSCEOLA MO
64776-0570
US

V. Phone/Fax

Practice location:
  • Phone: 417-646-8123
  • Fax:
Mailing address:
  • Phone: 417-646-8123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DELORES B BRACHER
Title or Position: SR. BILLING CLERK
Credential:
Phone: 660-476-2121