Provider Demographics
NPI:1053444687
Name:COMMUNITY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:COMMUNITY MEMORIAL HOSPITAL
Other - Org Name:AC RURAL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR BILLING CLERK
Authorized Official - Prefix:
Authorized Official - First Name:DELORES
Authorized Official - Middle Name:B
Authorized Official - Last Name:BRACHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-476-2121
Mailing Address - Street 1:408 E 7TH ST, PO BOX 97
Mailing Address - Street 2:
Mailing Address - City:APPLETON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64724-1402
Mailing Address - Country:US
Mailing Address - Phone:660-476-2121
Mailing Address - Fax:660-476-2130
Practice Address - Street 1:408 E 7TH ST
Practice Address - Street 2:
Practice Address - City:APPLETON CITY
Practice Address - State:MO
Practice Address - Zip Code:64724-1402
Practice Address - Country:US
Practice Address - Phone:660-476-2121
Practice Address - Fax:660-476-2130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO3640000Medicare PIN