Healthcare Provider Details

I. General information

NPI: 1134199417
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: 11/06/2024
Certification Date: 11/06/2024
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 HWY 72
SALEM MO
65560-0774
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number252-34
License Number StateMO

VIII. Authorized Official

Name: MRS. BROOKE BOLLMAN
Title or Position: CEO
Credential:
Phone: 573-729-6626