Healthcare Provider Details

I. General information

NPI: 1639177561
Provider Name (Legal Business Name): SALEM MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 01/20/2010
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
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 Code282NC0060X
TaxonomyCritical Access Hospital
License Number58567
License Number StateMO

VIII. Authorized Official

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