1093188807 NPI number — CAMERON REGIONAL MEDICAL CENTER INC

Table of content: (NPI 1093188807)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093188807 NPI number — CAMERON REGIONAL MEDICAL CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAMERON REGIONAL MEDICAL CENTER INC
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:
MAYSVILLE FAMILY HEALTH CLINIC
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:
1093188807
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/26/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1600 E EVERGREEN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAMERON
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64429-2400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-632-2101
Provider Business Mailing Address Fax Number:
816-649-3383

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1007 S POLK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAYSVILLE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64469-4030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-449-2123
Provider Business Practice Location Address Fax Number:
816-449-2125
Provider Enumeration Date:
11/03/2015

Additional Information

Authorized Official

Authorized Official Last Name:
ABRUTZ
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
F
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
816-632-2101

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X , with the licence number:  473-13 , 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)





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