Provider Demographics
NPI:1114177557
Name:SALEM MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:SALEM MEMORIAL HOSPITAL
Other - Org Name:SMDH FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HOSPITAL ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:P
Authorized Official - Last Name:PRYOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-729-6626
Mailing Address - Street 1:P.O. BOX 719
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MO
Mailing Address - Zip Code:65560-0719
Mailing Address - Country:US
Mailing Address - Phone:573-739-6020
Mailing Address - Fax:573-739-6021
Practice Address - Street 1:35629 HWY. 72
Practice Address - Street 2:BLD. 3
Practice Address - City:SALEM
Practice Address - State:MO
Practice Address - Zip Code:65560-0719
Practice Address - Country:US
Practice Address - Phone:573-739-6020
Practice Address - Fax:573-739-6021
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SALEM MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-23
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA1429Medicare PIN