Healthcare Provider Details

I. General information

NPI: 1174542682
Provider Name (Legal Business Name): HANNIBAL REGIONAL HEALTHCARE SYSTEM, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 10/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S CENTER ST
SHELBINA MO
63468-1404
US

IV. Provider business mailing address

6000 HOSPITAL DRIVE
HANNIBAL MO
63401-0551
US

V. Phone/Fax

Practice location:
  • Phone: 573-588-4131
  • Fax: 573-588-4876
Mailing address:
  • Phone: 573-248-1300
  • Fax:

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: ROGER J DIX
Title or Position: CFO
Credential:
Phone: 573-248-1300