1295058287 NPI number — SALT RIVER COMMUNITY HEALTH CENTER

Table of content: (NPI 1295058287)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295058287 NPI number — SALT RIVER COMMUNITY HEALTH CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SALT RIVER COMMUNITY HEALTH 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:
1295058287
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/01/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3145 N HIGHWAY 61
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HANNIBAL
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63401-6588
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-221-4422
Provider Business Mailing Address Fax Number:
537-221-4403

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
248 N MORGAN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KAHOKA
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63445-1433
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
660-727-1500
Provider Business Practice Location Address Fax Number:
660-727-1502
Provider Enumeration Date:
03/05/2010

Additional Information

Authorized Official

Authorized Official Last Name:
HYNEK
Authorized Official First Name:
JOAN
Authorized Official Middle Name:
F
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
573-221-4422

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X , with the licence number:  19782870 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1750422457 . This is a "NPI (PARENT ORGANIZATION)" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 833215221 . This is a "MEDICARE-PTAN" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com