Provider Demographics
NPI:1114348083
Name:HARRISON COUNTY COMMUNITY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:HARRISON COUNTY COMMUNITY HOSPITAL DISTRICT
Other - Org Name:NORTH HARRISON MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLESPIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-425-2211
Mailing Address - Street 1:16027 LOCUST STREET
Mailing Address - Street 2:
Mailing Address - City:EAGLEVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64442
Mailing Address - Country:US
Mailing Address - Phone:660-867-5111
Mailing Address - Fax:660-867-3111
Practice Address - Street 1:16027 LOCUST STREET
Practice Address - Street 2:
Practice Address - City:EAGLEVILLE
Practice Address - State:MO
Practice Address - Zip Code:64442
Practice Address - Country:US
Practice Address - Phone:660-867-5111
Practice Address - Fax:660-867-3111
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HARRISON COUNTY COMMUNITY HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-12-19
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
268714Medicare Oscar/Certification