Provider Demographics
NPI:1134304603
Name:ST. CLAIR COUNTY HOSPITAL DISTRICT NO. 1
Entity Type:Organization
Organization Name:ST. CLAIR COUNTY HOSPITAL DISTRICT NO. 1
Other - Org Name:SAC-OSAGE HOSPITAL LAKE AREA PRIMARY CARE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE MANAGET
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALMA
Authorized Official - Middle Name:F
Authorized Official - Last Name:RODABAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-646-5015
Mailing Address - Street 1:PO BOX 38
Mailing Address - Street 2:HWY 54 EAST
Mailing Address - City:WHEATLAND
Mailing Address - State:MO
Mailing Address - Zip Code:65779-0038
Mailing Address - Country:US
Mailing Address - Phone:417-282-5882
Mailing Address - Fax:
Practice Address - Street 1:700 GIESLER RD
Practice Address - Street 2:
Practice Address - City:OSCEOLA
Practice Address - State:MO
Practice Address - Zip Code:64776-6279
Practice Address - Country:US
Practice Address - Phone:417-646-8181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care