Provider Demographics
NPI:1164587770
Name:TEXAS COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:TEXAS COUNTY MEMORIAL HOSPITAL
Other - Org Name:HUTCHESON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-967-3311
Mailing Address - Street 1:1422 S SAM HOUSTON BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:MO
Mailing Address - Zip Code:65483-2130
Mailing Address - Country:US
Mailing Address - Phone:417-967-4139
Mailing Address - Fax:417-967-4130
Practice Address - Street 1:1422 S SAM HOUSTON BLVD STE 100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:MO
Practice Address - Zip Code:65483
Practice Address - Country:US
Practice Address - Phone:417-967-4139
Practice Address - Fax:417-967-4130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MO20120262563336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO600059109Medicaid
MO2614700OtherNCPDP
2136307OtherPK