1710004486 NPI number — TEXAS COUNTY MEMORIAL HOSPITAL

Table of content: (NPI 1710004486)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710004486 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:
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:
1710004486
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/11/2011
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:
SUITE 200
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:
1337 S SAM HOUSTON BLVD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65483-2046
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-967-5435
Provider Business Practice Location Address Fax Number:
417-967-5503
Provider Enumeration Date:
03/26/2007

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: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 597780303 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 26D0889777 . This is a "CLIA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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