1659675536 NPI number — PIGGOTT COMMUNITY HOSPITAL

Table of content: (NPI 1659675536)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659675536 NPI number — PIGGOTT COMMUNITY HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PIGGOTT COMMUNITY 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:
CAMPBELL HOME HEALTH AGENCY
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:
1659675536
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/26/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
115 N ASH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAMPBELL
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63933-1505
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-246-2882
Provider Business Mailing Address Fax Number:
573-246-2122

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
115 N ASH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMPBELL
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63933-1505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
873-246-2882
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/06/2011

Additional Information

Authorized Official

Authorized Official Last Name:
MAGEE
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
Authorized Official Title or Position:
EXEC DIRECTOR
Authorized Official Telephone Number:
870-598-3881

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  196-20 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 581359908 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 196-20 . This is a "MO LICENSE NUMBER" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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