1326349861 NPI number — LINCOLN COUNTY MEMORIAL HOSPITAL

Table of content: SHIRLEY JEAN CHAMPOUX LMP (NPI 1841273794)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326349861 NPI number — LINCOLN COUNTY MEMORIAL HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LINCOLN 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:
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:
1326349861
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/22/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 E CHERRY ST
Provider Second Line Business Mailing Address:
ATTN: PULMONARY CLINIC 3RD FLOOR
Provider Business Mailing Address City Name:
TROY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63379-1513
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-358-9518
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 E CHERRY ST
Provider Second Line Business Practice Location Address:
ATTN: PULMONARY CLINIC 3RD FLOOR
Provider Business Practice Location Address City Name:
TROY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63379-1513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-358-9518
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/16/2010

Additional Information

Authorized Official

Authorized Official Last Name:
BIRA
Authorized Official First Name:
PATRICK
Authorized Official Middle Name:
G.
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
636-528-3326

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  32884 , 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)





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