1326108226 NPI number — DEXTER HOSPITAL LLC

Table of content: JOANN D. MACMILLAN M.D. (NPI 1821002130)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326108226 NPI number — DEXTER HOSPITAL LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEXTER HOSPITAL LLC
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:
6
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:
1326108226
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 368
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEXTER
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63841
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-624-3165
Provider Business Mailing Address Fax Number:
573-624-3157

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1003 HIGHWAY 25 NORTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLOOMFIELD
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63825
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-568-3686
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
SUE ANN
Authorized Official Middle Name:
Authorized Official Title or Position:
CLINIC ADMINISTRATOR
Authorized Official Telephone Number:
573-624-1640

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , 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: DC5318 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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