Provider Demographics
NPI:1104801547
Name:BARTON COUNTY MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:BARTON COUNTY MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERIM CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUVALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-681-5105
Mailing Address - Street 1:29 NW 1ST LN
Mailing Address - Street 2:
Mailing Address - City:LAMAR
Mailing Address - State:MO
Mailing Address - Zip Code:64759-8105
Mailing Address - Country:US
Mailing Address - Phone:417-681-5100
Mailing Address - Fax:417-681-5501
Practice Address - Street 1:29 NW 1ST LN
Practice Address - Street 2:
Practice Address - City:LAMAR
Practice Address - State:MO
Practice Address - Zip Code:64759-8105
Practice Address - Country:US
Practice Address - Phone:417-681-5100
Practice Address - Fax:417-681-5501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-08
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO115-49275N00000X, 282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100101910AMedicaid
MO010421402Medicaid
MO0467640001Medicare NSC
KS100101910AMedicaid
MO261325Medicare Oscar/Certification
MO26Z325Medicare Oscar/Certification