Provider Demographics
NPI:1194783506
Name:FARMINGTON MISSOURI HOSPITAL COMPANY, LLC
Entity type:Organization
Organization Name:FARMINGTON MISSOURI HOSPITAL COMPANY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP, REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:S
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:COFFEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-764-3009
Mailing Address - Street 1:1212 WEBER RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-3325
Mailing Address - Country:US
Mailing Address - Phone:573-756-4581
Mailing Address - Fax:573-756-5834
Practice Address - Street 1:1212 WEBER RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-3325
Practice Address - Country:US
Practice Address - Phone:573-756-4581
Practice Address - Fax:573-756-5834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO319-14251E00000X
MO184-46273R00000X, 275N00000X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No251E00000XAgenciesHome Health
No273R00000XHospital UnitsPsychiatric Unit
No275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO26U116Medicare Oscar/Certification
MO26S116Medicare Oscar/Certification
MO267297Medicare Oscar/Certification
MO260116Medicare Oscar/Certification