Provider Demographics
NPI:1104129733
Name:BARTON COUNTY MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:BARTON COUNTY MEMORIAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINIC BUSINESS COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TJ
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-681-0214
Mailing Address - Street 1:102 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:LAMAR
Mailing Address - State:MO
Mailing Address - Zip Code:64759-1029
Mailing Address - Country:US
Mailing Address - Phone:417-681-0214
Mailing Address - Fax:417-681-0136
Practice Address - Street 1:102 W 2ND ST
Practice Address - Street 2:
Practice Address - City:LAMAR
Practice Address - State:MO
Practice Address - Zip Code:64759-1029
Practice Address - Country:US
Practice Address - Phone:417-681-0214
Practice Address - Fax:417-681-0136
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BARTON COUNTY MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-12-21
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208600000X
MOR8N54207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1235169723OtherJOSEPH F WILSON, JR, DO
MO1104129733Medicaid
MO000050010OtherMEDICARE GROUP NUMBER
1083614291OtherDAVID E BROWN DO
MOE78093Medicare UPIN
MO1104129733Medicaid