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General NPI Number Information
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NPI Number | 1528067113
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Entity Type | Organization
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Legal Business Name | CARROLL COUNTY MEMORIAL HOSPITAL
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Dates
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Enumeration Date | 07/18/2005
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Last Update Date | 10/29/2021
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Provider Practice Location Address
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Address Line | 1502 N JEFFERSON ST
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City | CARROLLTON
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State | MO
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Zip | 64633-1948
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Country | US
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Telephone | 660-542-1695
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Fax | 660-542-0363
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Provider Business Mailing Address
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Address Line | 1502 N JEFFERSON
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City | CARROLLTON
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State | MO
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Zip | 64633-1948
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Country | US
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Telephone | 660-542-1695
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Fax | 660-542-0363
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Authorized Official
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Title or Position | CFO
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Name | AMY DANIELLE IRELAND
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Credential |
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Telephone | 660-329-6005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 275N00000X
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Taxonomy Name | Medicare Defined Swing Bed Hospital Unit
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License Number | 26Z332
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 275N00000X
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Taxonomy Name | Medicare Defined Swing Bed Hospital Unit
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License Number |
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 282NC0060X
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Taxonomy Name | Critical Access Hospital
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License Number | 210-45
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License Number State | MO
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