Healthcare Provider Details

I. General information

NPI: 1114327954
Provider Name (Legal Business Name): PERRY COUNTY HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2014
Last Update Date: 09/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1508 EDGEMONT BLVD
PERRYVILLE MO
63775-1231
US

IV. Provider business mailing address

212 HOSPITAL LN SUITE 101
PERRYVILLE MO
63775-1224
US

V. Phone/Fax

Practice location:
  • Phone: 573-768-3220
  • Fax:
Mailing address:
  • Phone: 573-768-3220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PATRICK CARRON
Title or Position: CEO
Credential:
Phone: 573-547-2536