1114177557 NPI number — SALEM MEMORIAL HOSPITAL

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114177557 NPI number — SALEM MEMORIAL HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SALEM 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:
SMDH FAMILY MEDICINE
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:
1114177557
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/21/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 719
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALEM
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65560-0719
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-739-6020
Provider Business Mailing Address Fax Number:
573-739-6021

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
35629 HWY. 72
Provider Second Line Business Practice Location Address:
BLD. 3
Provider Business Practice Location Address City Name:
SALEM
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65560-0719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-739-6020
Provider Business Practice Location Address Fax Number:
573-739-6021
Provider Enumeration Date:
09/23/2008

Additional Information

Authorized Official

Authorized Official Last Name:
PRYOR
Authorized Official First Name:
DENNIS
Authorized Official Middle Name:
P
Authorized Official Title or Position:
HOSPITAL ADMINISTRATOR
Authorized Official Telephone Number:
573-729-6626

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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