Active NPI
Salem Memorial Hospital
- Nursing Facility/Intermediate Care Facility
- Salem, MO
National Provider Identifier
1174596928
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nursing Facility/Intermediate Care Facility
- License
- 25234
- Legal business name
- SALEM MEMORIAL HOSPITAL
- Practice address
- 35629 Highway 72
Salem, MO 65560-7217 - Phone
- (573) 729-6626
- Fax
- (573) 729-6502
- NPI assigned
- Feb 10, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Brooke Bollman
- Title
- Ceo
- Phone
- (573) 739-1927
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nursing Facility/Intermediate Care Facility | 313M00000X | 25234 | MO | Primary |
Addresses
Primary practice location
35629 Highway 72
Salem, MO 65560-7217
Mailing address
PO Box 774
35629 Highway 72
Salem, MO 65560-0774
Phone (573) 729-6626
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100570308 | Medicaid | MO |
National Provider Directory
National Provider Directory- Tax ID family
- Salem Memorial Hospital
Other organizations with this tax ID 4
Organizations that report the same tax identification number in the National Provider Directory.
-
- Ambulance
- Salem, MO
- NPI 1053382382
-
dba SMDH Family Medicine
- Primary Care Clinic/Center
- Salem, MO
- NPI 1114177557
-
- Emergency Medicine Physician
- Salem, MO
- NPI 1548232283
-
dba SMDH Family Medicine
- Rural Health Clinic/Center
- Salem, MO
- NPI 1821243981
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Internal Medicine Physician
- Salem, MO
- NPI 1659442028
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139529600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1775433600000",
"number": "1174596928",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 774",
"address_2": "35629 HIGHWAY 72",
"city": "SALEM",
"state": "MO",
"postal_code": "655600774",
"telephone_number": "573-729-6626",
"fax_number": "573-729-6502"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "35629 HIGHWAY 72",
"city": "SALEM",
"state": "MO",
"postal_code": "655607217",
"telephone_number": "573-729-6626",
"fax_number": "573-729-6502"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SALEM MEMORIAL HOSPITAL",
"organizational_subpart": "NO",
"enumeration_date": "2006-02-10",
"last_updated": "2026-04-06",
"certification_date": "2026-04-06",
"status": "A",
"authorized_official_last_name": "BOLLMAN",
"authorized_official_first_name": "BROOKE",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "573-739-1927"
},
"taxonomies": [
{
"code": "313M00000X",
"taxonomy_group": "",
"desc": "Nursing Facility/Intermediate Care Facility",
"state": "MO",
"license": "25234",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100570308",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Salem, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.