Provider Demographics
NPI:1295030807
Name:STE GENEVIEVE COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:STE GENEVIEVE COUNTY MEMORIAL HOSPITAL
Other - Org Name:ME'TIS BREAST CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-883-7703
Mailing Address - Street 1:120 PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:STE GENEVIEVE
Mailing Address - State:MO
Mailing Address - Zip Code:63670-1828
Mailing Address - Country:US
Mailing Address - Phone:573-883-5717
Mailing Address - Fax:573-883-3684
Practice Address - Street 1:120 PLAZA DR
Practice Address - Street 2:
Practice Address - City:STE GENEVIEVE
Practice Address - State:MO
Practice Address - Zip Code:63670-1828
Practice Address - Country:US
Practice Address - Phone:573-883-2782
Practice Address - Fax:573-883-3684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-13
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO504887308Medicaid
MOCC8331OtherRAILROAD MEDICARE
MO000012966Medicare PIN