Provider Demographics
NPI:1083624647
Name:SCOTLAND COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:SCOTLAND COUNTY MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:R
Authorized Official - Last Name:DIAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-465-8511
Mailing Address - Street 1:450 E SIGLER AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:MO
Mailing Address - Zip Code:63555-1726
Mailing Address - Country:US
Mailing Address - Phone:660-465-8511
Mailing Address - Fax:660-465-2956
Practice Address - Street 1:450 E SIGLER AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:MO
Practice Address - Zip Code:63555-1726
Practice Address - Country:US
Practice Address - Phone:660-465-8511
Practice Address - Fax:660-465-2956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO363-17282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO010325603Medicaid
MO261310Medicare Oscar/Certification
MO261310Medicare PIN