MEDICARE: HERMANN AREA HOSPITAL DISTRICT

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	:	1811062375
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HERMANN AREA HOSPITAL DISTRICT

Provider Business Mailing Address
First Line	:	PO BOX 19
Second Line	:
City	:	HERMANN
State	:	MO
Zip	:	65041-0019
Country	:	US
Telephone Number	:	573-486-1193
Fax Number	:	573-486-0910

Provider Business Practice Location Address
First Line	:	504 N STURGEON ST
Second Line	:
City	:	MONTGOMERY CITY
State	:	MO
Zip	:	63361-1829
Country	:	US
Telephone Number	:	573-564-2990
Fax Number	:	573-564-2963

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	DAN MCKINNEY
Credential	:
Telephone Number	:	573-486-2191

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	04/24/2009

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