Provider Demographics
NPI:1194731539
Name:LINCOLN COUNTY MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:LINCOLN COUNTY MEMORIAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:G
Authorized Official - Last Name:BIRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-528-8551
Mailing Address - Street 1:900 E CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MO
Mailing Address - Zip Code:63379-1429
Mailing Address - Country:US
Mailing Address - Phone:636-528-8585
Mailing Address - Fax:636-528-8430
Practice Address - Street 1:900 E CHERRY ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MO
Practice Address - Zip Code:63379-1429
Practice Address - Country:US
Practice Address - Phone:636-528-8585
Practice Address - Fax:636-528-8430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO500419809Medicaid
MO590419800Medicaid
MO500419809Medicaid
MO000012436Medicare PIN