1679648661 NPI number — HERMANN AREA HOSPITAL DISTRICT

Table of content: (NPI 1679648661)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679648661 NPI number — HERMANN AREA HOSPITAL DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HERMANN AREA HOSPITAL DISTRICT
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:
HERMANN AREA DISTRICT HOSPITAL
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:
1679648661
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/23/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 470
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HERMANN
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65041-0470
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-486-2191
Provider Business Mailing Address Fax Number:
573-486-3743

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
509 WEST 18TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HERMANN
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65041
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-486-2191
Provider Business Practice Location Address Fax Number:
573-486-3743
Provider Enumeration Date:
11/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCKINNEY
Authorized Official First Name:
DAN
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
573-486-2191

Provider Taxonomy Codes

  • Taxonomy code: 275N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 282NC0060X , with the licence number: 238-39 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 107603 . This is a "HEALTHLINK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 45827 . This is a "GROUP HEALTH PLAN" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 5020050 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 77 . This is a "BLUE CROSS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 261314 . This is a "MERCY" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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