Healthcare Provider Details

I. General information

NPI: 1699873372
Provider Name (Legal Business Name): PEMISCOT COUNTY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 05/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 E MAIN ST
PORTAGEVILLE MO
63873-1616
US

IV. Provider business mailing address

314 E MAIN ST
PORTAGEVILLE MO
63873-1616
US

V. Phone/Fax

Practice location:
  • Phone: 573-379-3777
  • Fax: 573-379-9331
Mailing address:
  • Phone: 573-379-3777
  • Fax: 573-379-9331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MARK R DAVIS
Title or Position: CEO
Credential:
Phone: 573-359-3612