Provider Demographics
NPI:1306336086
Name:PERRY COUNTY HEALTH SYSTEM
Entity type:Organization
Organization Name:PERRY COUNTY HEALTH SYSTEM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-547-2563
Mailing Address - Street 1:434 N WEST ST
Mailing Address - Street 2:
Mailing Address - City:PERRYVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63775
Mailing Address - Country:US
Mailing Address - Phone:573-768-3347
Mailing Address - Fax:573-768-3262
Practice Address - Street 1:434 N WEST ST
Practice Address - Street 2:
Practice Address - City:PERRYVILLE
Practice Address - State:MO
Practice Address - Zip Code:63775
Practice Address - Country:US
Practice Address - Phone:573-768-3347
Practice Address - Fax:573-768-3262
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PERRY COUNTY HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-05-17
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO442-19282NC0060X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO010157204Medicaid