Healthcare Provider Details

I. General information

NPI: 1427506039
Provider Name (Legal Business Name): PHELPS COUNTY REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2016
Last Update Date: 09/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W 10TH ST
ROLLA MO
65401-2905
US

IV. Provider business mailing address

1000 W 10TH ST
ROLLA MO
65401-2905
US

V. Phone/Fax

Practice location:
  • Phone: 573-458-8899
  • Fax: 573-458-8330
Mailing address:
  • Phone: 573-458-8899
  • Fax: 573-458-8330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number260017
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. CATHERINE EIKERMANN
Title or Position: COMPLIANCE OFFICER
Credential: MJ MSN
Phone: 573-458-7618