NPIMap

Organization Active NPI

Pike County Memorial Hospital

  • Critical Access Hospital
  • Louisiana, MO
National Provider Identifier
1437373545
Registry record updated May 21, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
85-48 Issued in 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
Last updated
May 21, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 21, 2008

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

Authorized official

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

Specialties & licenses 1

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

Addresses

Primary practice location

2305 Georgia St
Louisiana, MO 63353-2559

Mailing address

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1437373545. Details of each certification follow.

Hospital certification: CCN 26Z333

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

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

Other NPIs with the same Medicare PAC ID 5

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

National Provider Directory

National Provider Directory
Tax ID family
Eastern Missouri Helath8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Ownership & related parties

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 OfficerCeo 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

Owners & managing parties with NPI records 5

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

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 ClinicBowling Green, MO, CCN 263468 Rural health clinic Operational/Managerial Control Dec 31, 1991

Owned or controlled facilities with NPI records 1

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

Facilities with the same owner 1

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

Practitioners & affiliated clinicians

Affiliated clinicians 2

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

NPI Registry JSON

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

{
    "created_epoch": "1176336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211328000000",
    "number": "1437373545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2305 GEORGIA ST",
            "city": "LOUISIANA",
            "state": "MO",
            "postal_code": "633532559",
            "telephone_number": "573-754-5531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2305 GEORGIA ST",
            "city": "LOUISIANA",
            "state": "MO",
            "postal_code": "633532559",
            "telephone_number": "573-754-5531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PIKE COUNTY MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-12",
        "last_updated": "2008-05-21",
        "status": "A",
        "authorized_official_last_name": "HARNESS",
        "authorized_official_first_name": "LORRAINE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "573-754-5531",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "MO",
            "license": "85-48",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisiana, MO

Sources for this page

Verify at the official NPI Registry.