1396741302 NPI number — COMMUNITY HOSPITAL ASSOCIATION

Table of Contents

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:
COMMUNITY HOSPITAL-FAIRFAX
Provider Other Organization Name Type Code:
3
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".




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