1215906433 NPI number — CAPITAL REGION MEDICAL CENTER

Table of content: (NPI 1215906433)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215906433 NPI number — CAPITAL REGION MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAPITAL REGION MEDICAL CENTER
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:
1215906433
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/12/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 489
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STOVER
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65078
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-377-2313
Provider Business Mailing Address Fax Number:
573-377-4243

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2ND STREET AND OAK
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STOVER
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65078
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-377-2313
Provider Business Practice Location Address Fax Number:
573-377-4243
Provider Enumeration Date:
03/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCMILLAN
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
R
Authorized Official Title or Position:
VP FINANCE
Authorized Official Telephone Number:
573-632-5100

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 007100 . This is a "RR MEDICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com