Provider Demographics
NPI:1962529644
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 1:500 MAIN STREET
Mailing Address - Street 2:PO BOX 380
Mailing Address - City:CABOOL
Mailing Address - State:MO
Mailing Address - Zip Code:65689
Mailing Address - Country:US
Mailing Address - Phone:417-962-3015
Mailing Address - Fax:417-962-5938
Practice Address - Street 1:500 MAIN STREET
Practice Address - Street 2:
Practice Address - City:CABOOL
Practice Address - State:MO
Practice Address - Zip Code:65689
Practice Address - Country:US
Practice Address - Phone:417-962-3015
Practice Address - Fax:417-962-5938
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TEXAS COUNTY MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-26
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO597943901Medicaid
MO26D0859759OtherCLIA
MO597943901Medicaid
MO26-8603Medicare ID - Type UnspecifiedRH MEDICARE #