Provider Demographics
NPI:1154454551
Name:PINNACLE REGIONAL HOSPITAL,LLC
Entity Type:Organization
Organization Name:PINNACLE REGIONAL HOSPITAL,LLC
Other - Org Name:COOPER COUNTY RURAL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING CONTACT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:SKANES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-882-7461
Mailing Address - Street 1:17651 B HWY
Mailing Address - Street 2:
Mailing Address - City:BOONVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65233-2839
Mailing Address - Country:US
Mailing Address - Phone:660-882-7461
Mailing Address - Fax:660-882-6093
Practice Address - Street 1:17601 B HWY
Practice Address - Street 2:
Practice Address - City:BOONVILLE
Practice Address - State:MO
Practice Address - Zip Code:65233
Practice Address - Country:US
Practice Address - Phone:660-882-7461
Practice Address - Fax:660-882-6093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QR1300X
MO248-47261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO598132702Medicaid
MO263470Medicare Oscar/Certification