Healthcare Provider Details

I. General information

NPI: 1598737827
Provider Name (Legal Business Name): WASHINGTON COUNTY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 08/27/2020
Certification Date: 08/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HEALTH WAY DR
POTOSI MO
63664-1434
US

IV. Provider business mailing address

200 HEALTH WAY DR
POTOSI MO
63664-1434
US

V. Phone/Fax

Practice location:
  • Phone: 573-438-2977
  • Fax: 573-438-5460
Mailing address:
  • Phone: 573-438-2977
  • Fax: 573-438-5460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR6P28
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2002028056
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DEBRA PRATT
Title or Position: CFO
Credential:
Phone: 573-438-5451