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General NPI Number Information
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NPI Number | 1487735445
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Entity Type | Organization
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Legal Business Name | MISSOURI BAPTIST HOSPITAL OF SULLIVAN
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 03/23/2021
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Provider Practice Location Address
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Address Line | 510 WEST MAIN STREET
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City | STEELVILLE
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State | MO
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Zip | 65565
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Country | US
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Telephone | 573-775-4600
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Fax |
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Provider Business Mailing Address
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Address Line | 670 MASON RIDGE CENTER DR SUITE 300
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City | SAINT LOUIS
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State | MO
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Zip | 63141-8573
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Country | US
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Telephone | 314-996-7644
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Fax | 314-996-7658
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. TONY L SCHWARM
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Credential |
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Telephone | 573-468-1343
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | 355-24
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License Number State | MO
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