MEDICARE: LANDMARK HOSPITAL OF CAPE GIRARDEAU LLC

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	282E00000X	Long Term Care Hospital	496-0	MO

General Provider Information

NPI Number	:	1437105574
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LANDMARK HOSPITAL OF CAPE GIRARDEAU LLC

Provider Business Mailing Address
First Line	:	PO BOX 267
Second Line	:
City	:	JACKSON
State	:	MO
Zip	:	63755-0267
Country	:	US
Telephone Number	:	573-331-8412
Fax Number	:

Provider Business Practice Location Address
First Line	:	3255 INDEPENDENCE STREET
Second Line	:
City	:	CAPE GIRAREAU
State	:	MO
Zip	:	63701
Country	:	US
Telephone Number	:	573-335-1091
Fax Number	:	573-331-8453

Authorized Official
Title or Position	:	CFO
Name	:	TRACY LYNNE BOLLINGER
Credential	:	CPA
Telephone Number	:	573-450-2530

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	03/09/2026

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