Healthcare Provider Details

I. General information

NPI: 1821089657
Provider Name (Legal Business Name): SALEM MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2005
Last Update Date: 01/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35629 HIGHWAY 72 BLDG II
SALEM MO
65560-7217
US

IV. Provider business mailing address

PO BOX 69
SALEM MO
65560-0069
US

V. Phone/Fax

Practice location:
  • Phone: 573-729-6112
  • Fax: 573-729-4035
Mailing address:
  • Phone: 573-729-6112
  • Fax: 573-729-4035

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: MS. REBECCA CUNNINGHAM
Title or Position: CFO
Credential:
Phone: 573-729-6626