Provider Demographics
NPI:1235466715
Name:BARTON COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:BARTON COUNTY MEMORIAL HOSPITAL
Other - Org Name:LOCKWOOD CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF CLINIC
Authorized Official - Prefix:
Authorized Official - First Name:T
Authorized Official - Middle Name:J
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-232-5200
Mailing Address - Street 1:723 S. MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:LOCKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:65682
Mailing Address - Country:US
Mailing Address - Phone:417-232-5200
Mailing Address - Fax:417-232-5220
Practice Address - Street 1:723 S. MAIN ST.
Practice Address - Street 2:
Practice Address - City:LOCKWOOD
Practice Address - State:MO
Practice Address - Zip Code:65682
Practice Address - Country:US
Practice Address - Phone:417-232-5200
Practice Address - Fax:417-232-5220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-04
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO101370207Q00000X
MO106158207VG0400X
KS46126363LF0000X
MOF0499281363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO26-8624Medicare PIN