Provider Demographics
NPI:1114327954
Name:PERRY COUNTY HEALTH SYSTEM
Entity Type:Organization
Organization Name:PERRY COUNTY HEALTH SYSTEM
Other - Org Name:PFCC WEST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-547-2536
Mailing Address - Street 1:212 HOSPITAL LN
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PERRYVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63775-1224
Mailing Address - Country:US
Mailing Address - Phone:573-768-3220
Mailing Address - Fax:
Practice Address - Street 1:1508 EDGEMONT BLVD
Practice Address - Street 2:
Practice Address - City:PERRYVILLE
Practice Address - State:MO
Practice Address - Zip Code:63775-1231
Practice Address - Country:US
Practice Address - Phone:573-768-3220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-29
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1114327954Medicaid
268717Medicare Oscar/Certification
000014800Medicare PIN