Healthcare Provider Details

I. General information

NPI: 1396827804
Provider Name (Legal Business Name): ST. CLAIR COUNTY HOSPITAL DISTRICT NO. 1
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 ARDUSER DR
OSCEOLA MO
64776-6278
US

IV. Provider business mailing address

855 ARDUSER DR P.O. BOX 560
OSCEOLA MO
64776-6278
US

V. Phone/Fax

Practice location:
  • Phone: 417-646-8153
  • Fax: 417-646-8515
Mailing address:
  • Phone: 417-646-8153
  • Fax: 417-646-8515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number24238
License Number StateMO

VIII. Authorized Official

Name: MRS. JANA WITT
Title or Position: INTERIM ADMINISTRATOR
Credential:
Phone: 417-646-8181