Sullivan County Memorial Hospital
Organization Active NPI Emergency Medicine Physician · Milan, MO
NPI 1063553642 · NPPES record last updated May 16, 2011
Key facts
- NPI
- 1063553642
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Emergency Medicine Physician 207P00000X
- License
- 130-49 (MO)
- Legal business name
- SULLIVAN COUNTY MEMORIAL HOSPITAL
- Practice address
- 630 W 3Rd St
Milan, MO 63556-1076 - Phone
- (660) 265-4212
- Fax
- (660) 265-4898
- NPI assigned
- Feb 8, 2007
- Organization subpart
- No
Authorized official
- Name
- Amy Michael
- Title
- Chief Financial Officer
- Phone
- (660) 265-4212
Owned or controlled facilities with NPI records 2
Other NPIs on the same Medicare enrollment 4
Other NPIs with the same Medicare PAC ID 5
Corporate family (same tax ID) 7
Practitioners 21
-
Michael Edward Aberger, M.D.
-
Connie Lynn Barker, NP-C
-
Amy Creason, FNP
-
Dale Essmyer, D.O.
-
Sherri Lynn Hedges, APRN, FNP, BC
-
Deborah A.K Holte, DPM
-
Dawn Yvette Stout, RN, BCFNP
-
Ryan Williams, M.D.
-
Thomas Edwin Williams, D.O.
-
Vivian Marlene Hall, MSN, RN, BC, FNP
-
Robert Wayne Jackson, D.O.
-
Joshua David Delozier, DNAP
-
Larry R Handlin, DO
-
Linda Baldwin, DO
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
All facility ownership & control disclosures 2
| Facility | Type | Role | Since |
|---|---|---|---|
| Sullivan County Memorial Hospital Green City Clinic |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Jul 1, 2013 |
| Sullivan County Memorial Hospital Milan Family Practice |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Oct 1, 2015 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040626000444 | MO | Part B Supplier - Clinic/Group Practice | 7810973252 |
Receives reassigned benefits from 20 practitioners 4 other NPIs on this enrollment Practice locations: Milan, MO; Green City, MO |
National Provider Directory
- Tax ID family
- Milan Sullivan County a
Interoperability endpoints
- https://fhir-usa.unify.chbase.com/org/sulliva-d2785c8f
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician |
207P00000X | 130-49 | MO | Yes |
Addresses
Primary practice location
630 W 3Rd St
Milan, MO 63556-1076
Mailing address
630 W 3Rd St
Milan, MO 63556-1076
Phone (660) 265-4212
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 540324803 | Medicaid | MO |
Other providers in Milan, MO
- Katelin Rae Spratt I
- Kailee Stephenson
- Stover'S Residential Care Facility
- Sullivan County Ambulance District
- Sullivan County Health Department
- Sullivan County Memorial Hospital
- Sullivan County Memorial Hospital
- Sullivan County Memorial Hospital
- Sullivan County Memorial Hospital
- Sullivan County Memorial Hospital
All providers in Milan, MO · Emergency Medicine Physician in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 16, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.