Healthcare Provider Details

I. General information

NPI: 1043544695
Provider Name (Legal Business Name): HANNIBAL REGIONAL HEALTH CARE SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2009
Last Update Date: 05/25/2021
Certification Date: 05/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S CENTER ST
SHELBINA MO
63468-1404
US

IV. Provider business mailing address

6500 HOSPITAL DR
HANNIBAL MO
63401-6890
US

V. Phone/Fax

Practice location:
  • Phone: 573-588-4131
  • Fax:
Mailing address:
  • Phone: 573-248-1300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number083630
License Number StateMO

VIII. Authorized Official

Name: ROB GASAWAY
Title or Position: VP OF FINANCE
Credential:
Phone: 573-406-1608