Healthcare Provider Details

I. General information

NPI: 1750763322
Provider Name (Legal Business Name): PUTNAM COUNTY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2015
Last Update Date: 11/18/2019
Certification Date:
Deactivation Date: 07/24/2018
Reactivation Date: 11/18/2019

III. Provider practice location address

1926 OAK ST
UNIONVILLE MO
63565-1180
US

IV. Provider business mailing address

1926 OAK ST
UNIONVILLE MO
63565-1180
US

V. Phone/Fax

Practice location:
  • Phone: 660-947-2574
  • Fax: 660-947-2576
Mailing address:
  • Phone: 660-947-2574
  • Fax: 660-947-2576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2015019365
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MARIAH HOLLABAUGH
Title or Position: DIRECTOR OF PHARMACY
Credential:
Phone: 660-947-3673