Provider Demographics
NPI:1235204702
Name:HERMANN AREA HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:HERMANN AREA HOSPITAL DISTRICT
Other - Org Name:MEDICAL CLINIC OF OWENSVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-486-2191
Mailing Address - Street 1:PO BOX 19
Mailing Address - Street 2:
Mailing Address - City:HERMANN
Mailing Address - State:MO
Mailing Address - Zip Code:65041-0019
Mailing Address - Country:US
Mailing Address - Phone:573-486-1193
Mailing Address - Fax:573-486-0910
Practice Address - Street 1:708 E HIGHWAY 28
Practice Address - Street 2:
Practice Address - City:OWENSVILLE
Practice Address - State:MO
Practice Address - Zip Code:65066-1588
Practice Address - Country:US
Practice Address - Phone:573-437-4481
Practice Address - Fax:573-437-3232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO595803602Medicaid
268536Medicare Oscar/Certification