Provider Demographics
NPI:1104684703
Name:ADVANCE HANNIBAL REGIONAL HOSPITAL LLC
Entity type:Organization
Organization Name:ADVANCE HANNIBAL REGIONAL HOSPITAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:REIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-222-6800
Mailing Address - Street 1:160 PROGRESS RD STE 111
Mailing Address - Street 2:
Mailing Address - City:HANNIBAL
Mailing Address - State:MO
Mailing Address - Zip Code:63401-6630
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1811 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PALMYRA
Practice Address - State:MO
Practice Address - Zip Code:63461-1961
Practice Address - Country:US
Practice Address - Phone:573-773-3488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCE HANNIBAL REGIONAL HOSPITAL LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-03-08
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty