Provider Demographics
NPI:1326349861
Name:LINCOLN COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:LINCOLN COUNTY MEMORIAL HOSPITAL
Other - Org Name:LINCOLN COUNTY MEDICAL CENTER - PULMONARY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:G
Authorized Official - Last Name:BIRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-528-3326
Mailing Address - Street 1:1000 E CHERRY ST
Mailing Address - Street 2:ATTN: PULMONARY CLINIC 3RD FLOOR
Mailing Address - City:TROY
Mailing Address - State:MO
Mailing Address - Zip Code:63379-1513
Mailing Address - Country:US
Mailing Address - Phone:636-358-9518
Mailing Address - Fax:
Practice Address - Street 1:1000 E CHERRY ST
Practice Address - Street 2:ATTN: PULMONARY CLINIC 3RD FLOOR
Practice Address - City:TROY
Practice Address - State:MO
Practice Address - Zip Code:63379-1513
Practice Address - Country:US
Practice Address - Phone:636-358-9518
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-16
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO32884261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center