Healthcare Provider Details

I. General information

NPI: 1073521910
Provider Name (Legal Business Name): LINCOLN COUNTY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 12/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 EAST CHERRY STREET
TROY MO
63379
US

IV. Provider business mailing address

1000 E CHERRY ST
TROY MO
63379-1513
US

V. Phone/Fax

Practice location:
  • Phone: 636-528-3470
  • Fax: 636-528-3456
Mailing address:
  • Phone: 636-528-3470
  • Fax: 636-528-3456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number19121
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MARK A. THORN
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 636-528-3329