1649274606 NPI number — HARRISON COUNTY COMMUNITY HOSPITAL DISTRICT

Table of content: (NPI 1649274606)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649274606 NPI number — HARRISON COUNTY COMMUNITY HOSPITAL DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HARRISON COUNTY COMMUNITY HOSPITAL DISTRICT
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:
HOME HEALTH OF HARRISON COUNTY HOSPITAL
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:
1649274606
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2600 MILLER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BETHANY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64424-2701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
660-425-2211
Provider Business Mailing Address Fax Number:
660-425-8026

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2703 MILLER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BETHANY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64424-2704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
660-425-7863
Provider Business Practice Location Address Fax Number:
660-425-8026
Provider Enumeration Date:
06/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GILLESPIE
Authorized Official First Name:
CHRISTINA
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
660-425-2211

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 320900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 372500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3747P1801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 285125308 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 265125302 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 584726004 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 854726007 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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