Healthcare Provider Details

I. General information

NPI: 1497763361
Provider Name (Legal Business Name): MISSOURI BAPTIST HOSPITAL OF SULLIVAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 07/21/2022
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 SAPPINGTON BRIDGE RD
SULLIVAN MO
63080-2354
US

IV. Provider business mailing address

751 SAPPINGTON BRIDGE RD
SULLIVAN MO
63080-2354
US

V. Phone/Fax

Practice location:
  • Phone: 573-468-4186
  • Fax: 573-860-2696
Mailing address:
  • Phone: 573-468-1343
  • Fax: 573-860-2696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number355-24
License Number StateMO

VIII. Authorized Official

Name: MR. TONY L SCHWARM
Title or Position: PRESIDENT
Credential:
Phone: 573-468-1343