Provider Demographics
NPI:1205844982
Name:SCOTLAND COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:SCOTLAND COUNTY MEMORIAL HOSPITAL
Other - Org Name:MEMPHIS MEDICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARICIA
Authorized Official - Middle Name:R
Authorized Official - Last Name:DIAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-465-8511
Mailing Address - Street 1:450 E SIGLER AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MEMPHIS
Mailing Address - State:MO
Mailing Address - Zip Code:63555-1726
Mailing Address - Country:US
Mailing Address - Phone:660-465-2828
Mailing Address - Fax:660-465-2820
Practice Address - Street 1:450 E SIGLER AVE
Practice Address - Street 2:SUITE A
Practice Address - City:MEMPHIS
Practice Address - State:MO
Practice Address - Zip Code:63555-1726
Practice Address - Country:US
Practice Address - Phone:660-465-2828
Practice Address - Fax:660-465-2820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO599750205Medicaid
MO599750205Medicaid