Provider Demographics
NPI:1396755369
Name:MISSOURI BAPTIST HOSPITAL OF SULLIVAN
Entity type:Organization
Organization Name:MISSOURI BAPTIST HOSPITAL OF SULLIVAN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHWARM
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:573-468-1343
Mailing Address - Street 1:751 SAPPINGTON BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN
Mailing Address - State:MO
Mailing Address - Zip Code:63080-2354
Mailing Address - Country:US
Mailing Address - Phone:573-468-1343
Mailing Address - Fax:573-860-2696
Practice Address - Street 1:751 SAPPINGTON BRIDGE RD
Practice Address - Street 2:
Practice Address - City:SULLIVAN
Practice Address - State:MO
Practice Address - Zip Code:63080-2354
Practice Address - Country:US
Practice Address - Phone:573-468-4186
Practice Address - Fax:573-860-2696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
282NC0060X
MO355-24275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
No282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
108OtherBLUE CHOICE
260115OtherPREMIER PLUS
489665OtherAETNA
MO800565004Medicaid
108OtherBLUE CROSS-BLUE SHIELD
MO540565009Medicaid
MOMI010565000Medicaid
=========OtherGHP
=========OtherHEALTHCARE USA
=========OtherMERCY MC+
108OtherBLUE CROSS-BLUE SHIELD
=========OtherUNITED HEALTHCARE
MOMI010565000Medicaid
=========OtherHEALTHLINK
=========OtherTRICARE