Provider Demographics
NPI:1124125539
Name:PUTNAM COUNTY MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:PUTNAM COUNTY MEMORIAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS PAYABLE
Authorized Official - Prefix:MRS
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-947-2411
Mailing Address - Street 1:1926 OAK ST
Mailing Address - Street 2:PO BOX 389
Mailing Address - City:UNIONVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63565-1180
Mailing Address - Country:US
Mailing Address - Phone:660-947-2425
Mailing Address - Fax:660-947-7024
Practice Address - Street 1:1926 OAK ST
Practice Address - Street 2:
Practice Address - City:UNIONVILLE
Practice Address - State:MO
Practice Address - Zip Code:63565-1180
Practice Address - Country:US
Practice Address - Phone:660-947-2425
Practice Address - Fax:660-947-7024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO590322509Medicaid
IA0532713Medicaid
MO590322509Medicaid
MO263495Medicare Oscar/Certification