1235102690 NPI number — BOTHWELL REGIONAL HEALTH CENTER

Table of content: (NPI 1235102690)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235102690 NPI number — BOTHWELL REGIONAL HEALTH CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BOTHWELL REGIONAL HEALTH CENTER
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:
Provider Other Organization Name Type Code:
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:
1235102690
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/25/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
601 E 14TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEDALIA
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65301-5972
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
660-826-8833
Provider Business Mailing Address Fax Number:
660-827-3742

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 E 14TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEDALIA
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65301-5972
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
660-826-8833
Provider Business Practice Location Address Fax Number:
660-827-3742
Provider Enumeration Date:
02/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROBERTSON
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
660-827-9482

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  22-48 , 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: 90015010 . This is a "BLUE CROSS HOSPITAL" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 00185026 . This is a "BC PROFEE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 10157808 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00185016 . This is a "BC PROFEE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 113710 . This is a "HEALTHLINK ACUTE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 6192 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 540157807 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6191 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7754 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7756 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 90015030 . This is a "BC SURGERY" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 304950 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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