1295743169 NPI number — MISSOURI BAPTIST HOSPITAL OF SULLIVAN

Table of content: (NPI 1295743169)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295743169 NPI number — MISSOURI BAPTIST HOSPITAL OF SULLIVAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MISSOURI BAPTIST HOSPITAL OF SULLIVAN
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:
1295743169
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
751 SAPPINGTON BRIDGE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SULLIVAN
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63080-2354
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-468-1343
Provider Business Mailing Address Fax Number:
573-860-2696

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
751 SAPPINGTON BRIDGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SULLIVAN
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63080-2354
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-468-4186
Provider Business Practice Location Address Fax Number:
573-860-2696
Provider Enumeration Date:
08/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SCHWARM
Authorized Official First Name:
TONY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
573-468-1343

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QC0050X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: 355-24 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282NC0060X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 341600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 260115 . This is a "PREMIER PLUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 800565004 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: MI010565000 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 108 . This is a "BLUE CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 489665 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 540565009 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: CG2664 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: CE7443 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 108 . This is a "BLUE CROSS-BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 114117700 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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