Provider Demographics
NPI:1073587655
Name:STE GENEVIEVE COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:STE GENEVIEVE COUNTY MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-883-7703
Mailing Address - Street 1:800 STE GENEVIEVE DR
Mailing Address - Street 2:P.O. BOX 468
Mailing Address - City:STE GENEVIEVE
Mailing Address - State:MO
Mailing Address - Zip Code:63670-1434
Mailing Address - Country:US
Mailing Address - Phone:573-883-2751
Mailing Address - Fax:573-883-7796
Practice Address - Street 1:800 STE GENEVIEVE DR
Practice Address - Street 2:
Practice Address - City:STE GENEVIEVE
Practice Address - State:MO
Practice Address - Zip Code:63670-1434
Practice Address - Country:US
Practice Address - Phone:573-883-2751
Practice Address - Fax:573-883-7796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-13
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO245-36282N00000X, 282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO122837OtherBLUE CROSS ANES
MO540491800Medicaid
MO179240OtherBLUE SHEILD SOCIAL SERVIC
MO0000050912Medicare UPIN
MO179240OtherBLUE SHEILD SOCIAL SERVIC
MO261330Medicare PIN