Healthcare Provider Details

I. General information

NPI: 1407260961
Provider Name (Legal Business Name): LINCOLN COUNTY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2014
Last Update Date: 06/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1177 E CHERRY ST
TROY MO
63379-1520
US

IV. Provider business mailing address

1177 E CHERRY ST
TROY MO
63379-1520
US

V. Phone/Fax

Practice location:
  • Phone: 636-528-1919
  • Fax: 636-528-1916
Mailing address:
  • Phone: 636-528-1919
  • Fax: 636-528-1916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. MARK THORN
Title or Position: CFO
Credential:
Phone: 636-528-3329