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Pike County Memorial Hospital

Organization Active NPI Critical Access Hospital · Louisiana, MO

NPI 1437373545 · NPPES record last updated May 21, 2008

Key facts

NPI
1437373545
Entity type
Organization (NPI type 2)
Primary specialty
Critical Access Hospital 282NC0060X
License
85-48 (MO)
Legal business name
PIKE COUNTY MEMORIAL HOSPITAL
Practice address
2305 Georgia St
Louisiana, MO 63353-2559
Phone
(573) 754-5531
NPI assigned
Apr 12, 2007
Organization subpart
No

Authorized official

Name
Mrs. Lorraine Harness
Title
Administrator
Phone
(573) 754-5531

Owners & managing parties with NPI records 5

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Corporate family (same tax ID) 7

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

Facilities connected through Provider of Services related, parent or unit certification numbers.

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners 31

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 31

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

Medicare participation

Medicare fee-for-service enrollment
Enrolled in MO

Hospital certification: CCN 26Z333

Legal name
PIKE COUNTY MEMORIAL HOSPITAL
Doing business as
PIKE COUNTY MEMORIAL HOSPITAL
Organization structure
Other · Non-profit
Enrollment address
2305 Georgia St
Louisiana, MO 63353-2559
Other Hospital Practice Location

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Tylie Mills
Individual 		Corporate Officer
Ceo		 Jul 1, 2018
W-2 Managing Employee Jul 1, 2018
Pike County Memorial Hospital
Organization · Louisiana, MO 		Operational/Managerial Control Dec 7, 2005
Jeffrey Vanhorn
Individual 		Corporate Director Feb 11, 2021

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
PCMH Clinic
Bowling Green, MO · CCN 263468		 Rural health clinic Operational/Managerial Control Dec 31, 1991

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20120412000187 MO Part a Provider - Critical Access Hospital 8123015518 Practice locations: Louisiana, MO

National Provider Directory

Tax ID family
Pike County Memorial Ho (8 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 85-48 MO Yes

Addresses

Primary practice location

2305 Georgia St
Louisiana, MO 63353-2559

Mailing address

2305 Georgia St
Louisiana, MO 63353-2559
Phone (573) 754-5531

Other providers in Louisiana, MO

All providers in Louisiana, MO · Critical Access Hospital in Missouri

Sources for this page

Verify at the official NPI Registry.