Healthcare Provider Details

I. General information

NPI: 1033578588
Provider Name (Legal Business Name): PIKE COUNTY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2016
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 N GALLOWAY RD
VANDALIA MO
63382-1259
US

IV. Provider business mailing address

2305 GEORGIA ST
LOUISIANA MO
63353-2559
US

V. Phone/Fax

Practice location:
  • Phone: 573-754-5531
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. MCKAYLA JO WARTICK
Title or Position: DIRECTOR RCM
Credential:
Phone: 573-754-5531