1194972869 NPI number — FREEMAN-OAK HILL HEALTH SYSTEM

Table of content: (NPI 1194972869)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194972869 NPI number — FREEMAN-OAK HILL HEALTH SYSTEM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FREEMAN-OAK HILL HEALTH SYSTEM
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:
1194972869
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/18/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1532 W 32ND ST
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
JOPLIN
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64804-1607
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-347-7465
Provider Business Mailing Address Fax Number:
417-347-6465

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1532 W 32ND ST
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
JOPLIN
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64804-1607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-347-7465
Provider Business Practice Location Address Fax Number:
417-347-6465
Provider Enumeration Date:
08/25/2008

Additional Information

Authorized Official

Authorized Official Last Name:
WALKER
Authorized Official First Name:
CHRIS
Authorized Official Middle Name:
Authorized Official Title or Position:
DIR OF DURABLE MEDICAL SERVICES
Authorized Official Telephone Number:
417-347-7417

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1194972869 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100693570 , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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