Provider Demographics
NPI:1225382435
Name:HANNIBAL REGIONAL HOSPITAL
Entity Type:Organization
Organization Name:HANNIBAL REGIONAL HOSPITAL
Other - Org Name:HANNIBAL REGIONAL MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:DIX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-629-1609
Mailing Address - Street 1:6500 HOSPITAL DR
Mailing Address - Street 2:P O BOX 1239
Mailing Address - City:HANNIBAL
Mailing Address - State:MO
Mailing Address - Zip Code:63401-6890
Mailing Address - Country:US
Mailing Address - Phone:573-629-3370
Mailing Address - Fax:573-406-5750
Practice Address - Street 1:3145 HIGHWAY 61
Practice Address - Street 2:SUITE A
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401-6588
Practice Address - Country:US
Practice Address - Phone:573-629-3370
Practice Address - Fax:573-406-5750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-09
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health