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General NPI Number Information
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NPI Number | 1053499707
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Entity Type | Organization
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Legal Business Name | SKAGGS COMMUNITY HOSPITAL ASSOCIATION
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 09/15/2017
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Provider Practice Location Address
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Address Line | 2 KIMBERLING BLVD
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City | KIMBERLING CITY
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State | MO
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Zip | 65686
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Country | US
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Telephone | 417-739-2520
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Fax | 417-335-7544
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Provider Business Mailing Address
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Address Line | PO BOX 4046
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City | SPRINGFIELD
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State | MO
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Zip | 65807
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Country | US
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Telephone | 417-269-7241
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Fax | 417-269-7567
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Authorized Official
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Title or Position | CEO
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Name | MR. WILLIAM K. MAHONEY
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Credential |
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Telephone | 417-335-7270
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5248
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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