1518904531 NPI number — TEXAS COUNTY 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 1518904531 NPI number — TEXAS COUNTY MEMORIAL HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TEXAS 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:
TCMH FAMILY CLINIC & INTERNAL MEDICINE ASSOCIATES
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:
1518904531
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1337 S SAM HOUSTON BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65483-2046
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-967-5435
Provider Business Mailing Address Fax Number:
417-967-5503

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CABOOL
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65689
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-962-3015
Provider Business Practice Location Address Fax Number:
417-962-5938
Provider Enumeration Date:
05/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PAMPERIEN
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
417-967-3311

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 509319208 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 26D1006457 . This is a "CLIA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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