Healthcare Provider Details

I. General information

NPI: 1598945867
Provider Name (Legal Business Name): COMMUNITY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2007
Last Update Date: 01/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 GIESLER DR
OSCEOLA MO
64776-6297
US

IV. Provider business mailing address

101 GIESLER DR PO BOX 570
OSCEOLA MO
64776-6297
US

V. Phone/Fax

Practice location:
  • Phone: 417-646-8123
  • Fax: 417-646-8911
Mailing address:
  • Phone: 417-646-8123
  • Fax: 417-646-8911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number27033
License Number StateMO

VIII. Authorized Official

Name: MRS. PAM TADLOCK
Title or Position: BILLING SPECIALIST
Credential:
Phone: 417-646-8123