Moberly Hospital Company LLC
Organization Active NPI Medicare Defined Swing Bed Hospital Unit · Moberly, MO
NPI 1346212784 · NPPES record last updated Apr 16, 2021
Key facts
- NPI
- 1346212784
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Medicare Defined Swing Bed Hospital Unit 275N00000X
- License
- 423-9 (MO)
- Legal business name
- MOBERLY HOSPITAL COMPANY LLC
- Practice address
- 1515 Union Ave
Moberly, MO 65270-9407 - Phone
- (660) 263-8400
- NPI assigned
- Feb 1, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- MOBERLY HOSPITAL COMPANY LLC
Authorized official
- Name
- Paula M Lalor
- Title
- Director/Delegated Official
- Phone
- (629) 215-3953
Other NPIs with the same Medicare PAC ID 5
Corporate family (same tax ID) 5
Related certifications (CCN) 1
Facilities with the same owner 120
Practitioners 11
-
Erma Ruth Johnmeyer, FNP-C
-
Dana D Johnson, NP
-
Emily Carol Land, PA
-
Jon P Rampton, DO
-
Courtney Ramsey, NP
-
Susan Y Rasmussen, FNP
-
Philip Stitzer, DO
-
Haley Wiggans, FNP-BC
-
Tan Khac Nguyen, M.D.
Affiliated clinicians 3
-
Muhammad Naeem, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
Hospital certification: CCN 26U074
- Legal name
- MOBERLY HOSPITAL COMPANY LLC
- Doing business as
- MOBERLY REGIONAL MEDICAL CENTER
- Organization structure
- LLC · Proprietary
- Incorporated
- Oct 29, 2007 in DE
- Enrollment address
- 1515 Union Ave
Moberly, MO 65270-9407 - Hospital subgroups
- Short-term, Swing-bed approved
All disclosed owners & managing parties 13
| Name | Role | Since | Share |
|---|---|---|---|
| Kevin J Hammons |
Corporate Officer |
Apr 26, 2013 | |
| Corporate Director |
Jan 1, 2020 | ||
| Nathaniel K Summar |
Corporate Director |
Jul 15, 2017 | |
| Justin D Pitt |
Corporate Officer |
Mar 1, 2022 | |
| Corporate Director |
Mar 1, 2022 | ||
| William Bradley Cash |
Corporate Officer |
Jun 1, 2018 | |
| Community Health Systems Inc |
5% Or Greater Indirect Ownership Interest | Dec 31, 2007 | 100% |
| Jason Kevin Johnson |
Corporate Officer |
Jan 6, 2020 | |
| Michael D Hall |
W-2 Managing Employee |
Jun 25, 2022 | |
| Roman Gabriel Ottinger |
Corporate Officer |
Jan 6, 2020 | |
| Paula M Lalor |
Corporate Director |
Apr 1, 2017 | |
| Edna S Buffington-Price |
Corporate Director |
Mar 1, 2022 | |
| Community Health Investment Company LLC |
5% Or Greater Direct Ownership Interest | Dec 31, 2007 | 100% |
| Christopher G Cobb |
Corporate Officer |
Apr 1, 2017 | |
| CHS Community Health Systems Inc |
5% Or Greater Indirect Ownership Interest | Dec 31, 2007 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080404000751 | MO | Part a Provider - Hospital | 9436052230 | Practice locations: Moberly, MO |
National Provider Directory
- Tax ID family
- Moberly Regional Medica
- Part of
- Moberly Regional Medica
Locations
1310 San Bernardino Rd
Ste 207
Upland, CA 91786
Phone (909) 946-8600
1513 Union Ave
Ste 17002300
Moberly, MO 65270
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medicare Defined Swing Bed Hospital Unit | 275N00000X | 423-9 | MO | Yes |
Addresses
Primary practice location
1515 Union Ave
Moberly, MO 65270-9407
Mailing address
PO Box 60856
Saint Louis, MO 63160-0856
Other names
- Moberly Regional Medical Center
Other providers in Moberly, MO
- Moberly Health Care LLC
- Moberly Hospital Company LLC
- Moberly Hospital Company LLC
- Moberly Hospital Company LLC
- Moberly Hospital Company LLC
- Moberly Hospital Company LLC
- Moberly Hospital Company LLC
- Moberly Hospital Company LLC
- Moberly Hospital Company LLC
- Moberly Hospital Company LLC
All providers in Moberly, MO · Medicare Defined Swing Bed Hospital Unit in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 16, 2021. 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.