Provider Demographics
NPI:1407989510
Name:MOBERLY HOSPITAL COMPANY LLC
Entity Type:Organization
Organization Name:MOBERLY HOSPITAL COMPANY LLC
Other - Org Name:MOBERLY RURAL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR / DELEGATED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LALOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:629-215-3953
Mailing Address - Street 1:1501 UNION AVE
Mailing Address - Street 2:SUITE A & B
Mailing Address - City:MOBERLY
Mailing Address - State:MO
Mailing Address - Zip Code:65270-9469
Mailing Address - Country:US
Mailing Address - Phone:660-263-9095
Mailing Address - Fax:660-263-0054
Practice Address - Street 1:1501 UNION AVE
Practice Address - Street 2:SUITE A & B
Practice Address - City:MOBERLY
Practice Address - State:MO
Practice Address - Zip Code:65270-9469
Practice Address - Country:US
Practice Address - Phone:660-263-9095
Practice Address - Fax:660-263-0054
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOBERLY HOSPITAL COMPANY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-14
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X
MO261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO268611Medicare Oscar/Certification
MO000015287Medicare PIN