1104129733 NPI number — BARTON COUNTY MEMORIAL HOSPITAL

Table of content: (NPI 1104129733)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104129733 NPI number — BARTON COUNTY MEMORIAL HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BARTON 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:
MEDICAL ONE SATELLITE 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:
1104129733
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/22/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
102 W 2ND ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAMAR
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64759-1029
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-681-0214
Provider Business Mailing Address Fax Number:
417-681-0136

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
102 W 2ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAMAR
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64759-1029
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-681-0214
Provider Business Practice Location Address Fax Number:
417-681-0136
Provider Enumeration Date:
12/21/2010

Additional Information

Authorized Official

Authorized Official Last Name:
ALLEN
Authorized Official First Name:
TJ
Authorized Official Middle Name:
Authorized Official Title or Position:
CLINIC BUSINESS COORDINATOR
Authorized Official Telephone Number:
417-681-0214

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  R8N54 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1235169723 . This is a "JOSEPH F WILSON, JR, DO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1104129733 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000050010 . This is a "MEDICARE GROUP NUMBER" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 1083614291 . This is a "DAVID E BROWN DO" identifier . This identifiers is of the category "OTHER".




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