Sullivan County Memorial Hospital
Organization Active NPI Rural Health Clinic/Center · Newtown, MO
NPI 1770624967 · NPPES record last updated Sep 17, 2013
Key facts
- NPI
- 1770624967
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- License
- 130-55 (MO)
- Legal business name
- SULLIVAN COUNTY MEMORIAL HOSPITAL
- Practice address
- 106 North Main
Newtown, MO 64667-1000 - Phone
- (660) 794-5100
- Fax
- (660) 265-3406
- NPI assigned
- Feb 9, 2007
- Organization subpart
- No
Authorized official
- Name
- Amy Michael
- Title
- Chief Operating Officer
- Phone
- (660) 265-4212
Other NPIs on the same Medicare enrollment 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040626000444 | MO | Part B Supplier - Clinic/Group Practice | 7810973252 |
Receives reassigned benefits from 20 practitioners 4 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Milan, MO; Green City, MO |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | 130-55 | MO | Yes |
Addresses
Primary practice location
106 North Main
Newtown, MO 64667-1000
Mailing address
630 W 3Rd St
Milan, MO 63556-1076
Phone (660) 265-4212
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 540324803 | Medicaid | MO |
Other providers in Newtown, MO
All providers in Newtown, MO · Rural Health Clinic/Center in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 17, 2013. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.