1396741302 NPI number — COMMUNITY HOSPITAL ASSOCIATION

Table of content: (NPI 1396741302)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396741302 NPI number — COMMUNITY HOSPITAL ASSOCIATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY HOSPITAL ASSOCIATION
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:
1396741302
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/18/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 E CASS STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCK PORT
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64482-1528
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
660-744-5361
Provider Business Mailing Address Fax Number:
660-744-2247

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 E CASS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCK PORT
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64482-1528
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
660-744-5361
Provider Business Practice Location Address Fax Number:
660-744-2247
Provider Enumeration Date:
06/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
DAVIS
Authorized Official First Name:
JON
Authorized Official Middle Name:
P
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
660-686-2320

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 505428102 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 29516017 . This is a "BCBS KANSAS CITY MO" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com