MEDICARE: BATES COUNTY MEMORIAL HOSPITAL

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	261Q00000X	Clinic/Center	268646	MO
2	261Q00000X	Clinic/Center	268606	MO
3	261Q00000X	Clinic/Center	268639	MO
4	261QR1300X	Rural Health Clinic/Center	268606	MO
5	261QR1300X	Rural Health Clinic/Center	268646	MO
6	261QR1300X	Rural Health Clinic/Center	268639	MO
7	282N00000X	General Acute Care Hospital	205 45	MO

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
2	00125012	OTHER	MO	KC BC/BS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	90012015	OTHER	MO	KC BC/BS
5	0927601	OTHER	MO	KC BC/BS
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770536740
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BATES COUNTY MEMORIAL HOSPITAL

Provider Business Mailing Address
First Line	:	PO BOX 19793
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-4092
Country	:	US
Telephone Number	:	660-200-7000
Fax Number	:	660-200-7004

Provider Business Practice Location Address
First Line	:	615 W NURSERY ST
Second Line	:
City	:	BUTLER
State	:	MO
Zip	:	64730-1840
Country	:	US
Telephone Number	:	660-200-7000
Fax Number	:	660-200-7004

Authorized Official
Title or Position	:	CEO
Name	:	GREGORY WEAVER
Credential	:
Telephone Number	:	660-200-7000

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	03/17/2021

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1831142991 — MS. AIDA G LAWRENCE CRNA
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1053359844 — BATES COUNTY MEMORIAL HOSPITAL
Practice Location Address:

615 W NURSERY ST
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64730-1840

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Directions to “BATES COUNTY MEMORIAL HOSPITAL ” Practice Location

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