Provider Demographics
NPI:1275760829
Name:HEALTHMONT OF MISSOURI LLC
Entity Type:Organization
Organization Name:HEALTHMONT OF MISSOURI LLC
Other - Org Name:DBA CALLAWAY COMMUNITY HOSPITAL DBA SPECIALITY CLINICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:DEATON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-592-6521
Mailing Address - Street 1:850 W HOSPITAL DR
Mailing Address - Street 2:SUITE F
Mailing Address - City:FULTON
Mailing Address - State:MO
Mailing Address - Zip Code:65251-2535
Mailing Address - Country:US
Mailing Address - Phone:573-642-8280
Mailing Address - Fax:573-642-4686
Practice Address - Street 1:850 W HOSPITAL DR
Practice Address - Street 2:SUITE F
Practice Address - City:FULTON
Practice Address - State:MO
Practice Address - Zip Code:65251-2535
Practice Address - Country:US
Practice Address - Phone:573-642-5338
Practice Address - Fax:573-642-9224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-22
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty