Provider Demographics
NPI:1285957001
Name:TEXAS COUNTY MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:TEXAS COUNTY MEMORIAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:PAMPERIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-967-3311
Mailing Address - Street 1:1905 WEST 19TH STREET
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN GROVE
Mailing Address - State:MO
Mailing Address - Zip Code:65711
Mailing Address - Country:US
Mailing Address - Phone:417-926-1770
Mailing Address - Fax:417-926-1785
Practice Address - Street 1:1905 WEST 19TH STREET
Practice Address - Street 2:
Practice Address - City:MOUNTAIN GROVE
Practice Address - State:MO
Practice Address - Zip Code:65711
Practice Address - Country:US
Practice Address - Phone:417-926-1770
Practice Address - Fax:417-926-1785
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TEXAS COUNTY MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-08
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1285957001Medicaid
MO26D2006074OtherCLIA
MO1285957001Medicaid