Provider Demographics
NPI:1124220637
Name:MINERAL AREA OSTEOPATHIC HOSPITAL INC
Entity Type:Organization
Organization Name:MINERAL AREA OSTEOPATHIC HOSPITAL INC
Other - Org Name:MINERAL AREA REGIONAL MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACFO
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-701-7293
Mailing Address - Street 1:603 WALLACE ROAD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640
Mailing Address - Country:US
Mailing Address - Phone:573-756-3662
Mailing Address - Fax:573-756-3640
Practice Address - Street 1:1103 WEBER RD
Practice Address - Street 2:SUITE 102
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-3326
Practice Address - Country:US
Practice Address - Phone:573-756-3662
Practice Address - Fax:573-756-3640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO207Q00000X, 207R00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty