Healthcare Provider Details

I. General information

NPI: 1689508673
Provider Name (Legal Business Name): PHELPS COUNTY REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 W 10TH ST, SUITE 100
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: 573-458-3360
  • Fax: 573-458-3362
Mailing address:
  • Phone: 573-458-7892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KREIG L MOORE
Title or Position: EXEC DIR 340B & PHARM BUSS STRATEGY
Credential: R.PH., 340ACE
Phone: 573-458-7892