1093780678 NPI number — TEXAS COUNTY MEMORIAL HOSPITAL

Table of content: (NPI 1093780678)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093780678 NPI number — TEXAS COUNTY MEMORIAL HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TEXAS COUNTY MEMORIAL HOSPITAL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HOSPICE OF CARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093780678
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/15/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1333 S SAM HOUSTON BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65483-2046
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-967-1279
Provider Business Mailing Address Fax Number:
417-967-1335

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1422 S SAM HOUSTON BLVD STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65483-2119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-967-1279
Provider Business Practice Location Address Fax Number:
417-967-1335
Provider Enumeration Date:
02/17/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PAMPERIEN
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
417-967-3311

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  048-10HO , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 182 . This is a "BCBS NUMBER" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 820156503 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 048-23HO . This is a "MISSOURI LICENSE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".