NPIMap

Organization Active NPI

Hannibal Regional Hospital

  • Athletic Trainer
  • Hannibal, MO
National Provider Identifier
1174585103
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Athletic TrainerTaxonomy code 2255A2300X
License
2002030211 Issued in MO
Legal business name
HANNIBAL REGIONAL HOSPITAL
Practice address
188A Medical Dr
Hannibal, MO 63401-6877
Phone
(573) 406-0576
NPI assigned
Apr 5, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Carol Jaco
Title
Sr. Vice President of Patient Care
Phone
(573) 248-5257

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Athletic TrainerGroup: 193400000X SINGLE SPECIALTY GROUP 2255A2300X 2002030211 MO Primary

Addresses

Primary practice location

188A Medical Dr
Hannibal, MO 63401-6877

Mailing address

4537 W Ely Rd
#804
Hannibal, MO 63401-2546
Phone (573) 248-3889

National Provider Directory

National Provider Directory
Tax ID family
Center Family Practice33 organizations share this tax ID, including this one

Other organizations with this tax ID 32

Organizations that report the same tax identification number in the National Provider Directory.

View all 32

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1144195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1174585103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4537 W ELY RD",
            "address_2": "#804",
            "city": "HANNIBAL",
            "state": "MO",
            "postal_code": "634012546",
            "telephone_number": "573-248-3889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "188A MEDICAL DR",
            "city": "HANNIBAL",
            "state": "MO",
            "postal_code": "634016877",
            "telephone_number": "573-406-0576"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HANNIBAL REGIONAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JACO",
        "authorized_official_first_name": "CAROL",
        "authorized_official_title_or_position": "SR. VICE PRESIDENT OF PATIENT CARE",
        "authorized_official_telephone_number": "573-248-5257",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "MO",
            "license": "2002030211",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hannibal, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.