MEDICARE: KIRKSVILLE MISSOURI HOSPITAL COMPANY 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	261QR1300X	Rural Health Clinic/Center

General Provider Information

NPI Number	:	1508135005
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIRKSVILLE MISSOURI HOSPITAL COMPANY LLC

Provider Business Mailing Address
First Line	:	315 S OSTEOPATHY AVE
Second Line	:
City	:	KIRKSVILLE
State	:	MO
Zip	:	63501-6401
Country	:	US
Telephone Number	:	660-785-1000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1607 S BALTIMORE ST
Second Line	:
City	:	KIRKSVILLE
State	:	MO
Zip	:	63501-4536
Country	:	US
Telephone Number	:	660-627-3363
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR/DELEGATED OFFICIAL
Name	:	PAULA M LALOR
Credential	:
Telephone Number	:	629-215-3953

Provider Enumeration Date	:	12/29/2011
Last Update Date	:	04/08/2021

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