Provider Demographics
NPI:1093780678
Name:TEXAS COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:TEXAS COUNTY MEMORIAL HOSPITAL
Other - Org Name:HOSPICE OF CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:PAMPERIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-967-3311
Mailing Address - Street 1:1333 S SAM HOUSTON BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:MO
Mailing Address - Zip Code:65483-2046
Mailing Address - Country:US
Mailing Address - Phone:417-967-1279
Mailing Address - Fax:417-967-1335
Practice Address - Street 1:1422 S SAM HOUSTON BLVD STE 300
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:MO
Practice Address - Zip Code:65483-2119
Practice Address - Country:US
Practice Address - Phone:417-967-1279
Practice Address - Fax:417-967-1335
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TEXAS COUNTY MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-17
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO048-10HO251G00000X
251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO182OtherBCBS NUMBER
MO820156503Medicaid
MO048-23HOOtherMISSOURI LICENSE