Provider Demographics
NPI:1003956095
Name:HANNIBAL REGIONAL HEALTHCARE SYSTEM INC
Entity Type:Organization
Organization Name:HANNIBAL REGIONAL HEALTHCARE SYSTEM INC
Other - Org Name:HANNIBAL REGIONAL HOSPITAL PHYSICIANS
Other - Org Type:Other Name
Authorized Official - Title/Position:VP OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:N
Authorized Official - Last Name:GASAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-406-1608
Mailing Address - Street 1:6000 HOSPITAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:HANNIBAL
Mailing Address - State:MO
Mailing Address - Zip Code:63401
Mailing Address - Country:US
Mailing Address - Phone:573-248-1300
Mailing Address - Fax:573-248-5448
Practice Address - Street 1:6000 HOSPITAL DRIVE
Practice Address - Street 2:
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401
Practice Address - Country:US
Practice Address - Phone:573-248-1300
Practice Address - Fax:573-248-5448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO540416005Medicaid