Provider Demographics
NPI:1386728798
Name:ST. CLAIR COUNTY HOSPITAL DISTRICT #1
Entity type:Organization
Organization Name:ST. CLAIR COUNTY HOSPITAL DISTRICT #1
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:C
Authorized Official - Last Name:SMILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-646-8181
Mailing Address - Street 1:HWY 54 EAST
Mailing Address - Street 2:
Mailing Address - City:WHEATLAND
Mailing Address - State:MO
Mailing Address - Zip Code:65779-7501
Mailing Address - Country:US
Mailing Address - Phone:417-282-5882
Mailing Address - Fax:417-282-5681
Practice Address - Street 1:HWY 54 EAST
Practice Address - Street 2:
Practice Address - City:WHEATLAND
Practice Address - State:MO
Practice Address - Zip Code:65779
Practice Address - Country:US
Practice Address - Phone:417-282-5882
Practice Address - Fax:417-282-5681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO505985200Medicaid
MO000013727Medicare ID - Type UnspecifiedMEDICARE GROUP #
MO505985200Medicaid