MEDICARE: HANNIBAL REGIONAL HEALTHCARE SYSTEM, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR1300X	Rural Health Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174542682
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HANNIBAL REGIONAL HEALTHCARE SYSTEM, INC

Provider Business Mailing Address
First Line	:	6000 HOSPITAL DRIVE
Second Line	:
City	:	HANNIBAL
State	:	MO
Zip	:	63401-0551
Country	:	US
Telephone Number	:	573-248-1300
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 S CENTER ST
Second Line	:
City	:	SHELBINA
State	:	MO
Zip	:	63468-1404
Country	:	US
Telephone Number	:	573-588-4131
Fax Number	:	573-588-4876

Authorized Official
Title or Position	:	CFO
Name	:	ROGER J DIX
Credential	:
Telephone Number	:	573-248-1300

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	10/02/2014

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