Provider Demographics
NPI:1275656068
Name:CEDAR COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:CEDAR COUNTY MEMORIAL HOSPITAL
Other - Org Name:CEDAR COUNTY FAMILY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:W
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-876-2511
Mailing Address - Street 1:1401 S PARK ST
Mailing Address - Street 2:
Mailing Address - City:EL DORADO SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64744-2037
Mailing Address - Country:US
Mailing Address - Phone:417-876-2511
Mailing Address - Fax:417-876-3812
Practice Address - Street 1:807 OWENS MILL RD
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:MO
Practice Address - Zip Code:65785-8359
Practice Address - Country:US
Practice Address - Phone:417-276-5500
Practice Address - Fax:417-876-3812
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CEDAR COUNTY MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-09
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center