Provider Demographics
NPI:1093957128
Name:MCCUNE BROOKS REGIONAL HOSPITAL
Entity Type:Organization
Organization Name:MCCUNE BROOKS REGIONAL HOSPITAL
Other - Org Name:PHYSICIANS FOR WOMEN'S HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:Y
Authorized Official - Last Name:COPELAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-358-8121
Mailing Address - Street 1:1515 HAZEL ST STE 101
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:MO
Mailing Address - Zip Code:64836-2842
Mailing Address - Country:US
Mailing Address - Phone:417-358-0188
Mailing Address - Fax:417-358-4612
Practice Address - Street 1:1515 HAZEL ST STE 101
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:MO
Practice Address - Zip Code:64836-2842
Practice Address - Country:US
Practice Address - Phone:417-358-0188
Practice Address - Fax:417-358-4612
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MCCUNE BROOKS REGIONAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-06
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201469608Medicaid
MO203312038Medicaid
MO209731827Medicaid
MO209731827Medicaid
MOF25554Medicare UPIN
MO201469608Medicaid