Provider Demographics
NPI:1184648271
Name:LINCOLN COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:LINCOLN COUNTY MEMORIAL HOSPITAL
Other - Org Name:TROY FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:G
Authorized Official - Last Name:BIRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-528-8551
Mailing Address - Street 1:PO BOX 249
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MO
Mailing Address - Zip Code:63379-0249
Mailing Address - Country:US
Mailing Address - Phone:636-528-6755
Mailing Address - Fax:636-528-6965
Practice Address - Street 1:1003 E CHERRY ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MO
Practice Address - Zip Code:63379-1503
Practice Address - Country:US
Practice Address - Phone:636-528-6755
Practice Address - Fax:636-528-6965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO598223808Medicaid
MO263479Medicare Oscar/Certification
MO000013058Medicare PIN