Provider Demographics
NPI:1073532560
Name:HANNIBAL REGIONAL HOSPITAL
Entity Type:Organization
Organization Name:HANNIBAL REGIONAL HOSPITAL
Other - Org Name:CENTER FAMILY PRACTICE
Other - Org Type:Other Name
Authorized Official - Title/Position:VP OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:ROB
Authorized Official - Middle Name:
Authorized Official - Last Name:GASAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-406-1608
Mailing Address - Street 1:PO BOX 1239
Mailing Address - Street 2:
Mailing Address - City:HANNIBAL
Mailing Address - State:MO
Mailing Address - Zip Code:63401-1239
Mailing Address - Country:US
Mailing Address - Phone:573-221-3415
Mailing Address - Fax:
Practice Address - Street 1:401 EAST HWY 19
Practice Address - Street 2:
Practice Address - City:CENTER
Practice Address - State:MO
Practice Address - Zip Code:63436
Practice Address - Country:US
Practice Address - Phone:573-267-3318
Practice Address - Fax:573-267-3933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care