Provider Demographics
NPI:1336381755
Name:MCCUNE BROOKS REGIONAL HOSPITAL
Entity type:Organization
Organization Name:MCCUNE BROOKS REGIONAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:Y
Authorized Official - Last Name:COPELAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-358-8121
Mailing Address - Street 1:1911 BUENA VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:MO
Mailing Address - Zip Code:64836-3178
Mailing Address - Country:US
Mailing Address - Phone:417-237-0983
Mailing Address - Fax:417-237-0997
Practice Address - Street 1:1911 BUENA VISTA AVE
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:MO
Practice Address - Zip Code:64836-3178
Practice Address - Country:US
Practice Address - Phone:417-237-0983
Practice Address - Fax:417-237-0997
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MCCUNE BROOKS REGIONAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-03-31
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1006852080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty