Healthcare Provider Details

I. General information

NPI: 1225008543
Provider Name (Legal Business Name): SALEM MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 02/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35629 HIGHWAY 72
SALEM MO
65560-7217
US

IV. Provider business mailing address

PO BOX 774 35629 HIGHWAY 72
SALEM MO
65560-0774
US

V. Phone/Fax

Practice location:
  • Phone: 573-729-6626
  • Fax:
Mailing address:
  • Phone: 573-729-6626
  • Fax: 573-729-6502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number25234
License Number StateMO

VIII. Authorized Official

Name: MR. DENNIS P PRYOR
Title or Position: ADMINISTRATOR
Credential:
Phone: 573-729-6626