Healthcare Provider Details

I. General information

NPI: 1982699328
Provider Name (Legal Business Name): PERRY COUNTY HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 06/16/2022
Certification Date: 06/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

434 N WEST ST
PERRYVILLE MO
63775-1359
US

IV. Provider business mailing address

434 N WEST ST
PERRYVILLE MO
63775-1359
US

V. Phone/Fax

Practice location:
  • Phone: 573-547-2530
  • Fax: 573-517-0347
Mailing address:
  • Phone: 573-547-2530
  • Fax: 573-517-0347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number442-7
License Number StateMO

VIII. Authorized Official

Name: MICHAEL ELLIS
Title or Position: CFO
Credential:
Phone: 573-768-3207