=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992807390
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PEMISCOT COUNTY MEMORIAL HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/05/2006
-----------------------------------------------------
Last Update Date | 08/07/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1231 1ST ST STE 5
-----------------------------------------------------
City | KENNETT
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63857-2521
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-888-8828
-----------------------------------------------------
Fax | 573-888-8830
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 442
-----------------------------------------------------
City | HAYTI
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63851-0442
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-359-3659
-----------------------------------------------------
Fax | 573-359-3608
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | REVENUE CYCLE DIRECTOR
-----------------------------------------------------
Name | LAUREN TURNAGE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 573-359-3498
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR1300X
-----------------------------------------------------
Taxonomy Name | Rural Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------