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General NPI Number Information
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NPI Number | 1417937160
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Entity Type | Organization
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Legal Business Name | MCCUNE BROOKS HOSPITAL
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Dates
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Enumeration Date | 01/19/2006
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Last Update Date | 02/28/2012
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Provider Practice Location Address
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Address Line | 3125 DR RUSSELL SMITH WAY
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City | CARTHAGE
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State | MO
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Zip | 64836-7402
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Country | US
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Telephone | 417-358-8121
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Fax |
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Provider Business Mailing Address
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Address Line | 3125 DR RUSSELL SMITH WAY
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City | CARTHAGE
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State | MO
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Zip | 64836-7402
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Country | US
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Telephone | 417-358-8121
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. ROBERT Y COPELAND JR.
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Credential |
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Telephone | 417-358-8121
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 182.21
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License Number State | MO
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