Provider Demographics
NPI:1437105574
Name:LANDMARK HOSPITAL OF CAPE GIRARDEAU LLC
Entity Type:Organization
Organization Name:LANDMARK HOSPITAL OF CAPE GIRARDEAU LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:BOLLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:573-450-2530
Mailing Address - Street 1:3255 INDEPENDENCE STREET
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRAREAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701
Mailing Address - Country:US
Mailing Address - Phone:573-335-1091
Mailing Address - Fax:573-331-8453
Practice Address - Street 1:3255 INDEPENDENCE STREET
Practice Address - Street 2:
Practice Address - City:CAPE GIRAREAU
Practice Address - State:MO
Practice Address - Zip Code:63701
Practice Address - Country:US
Practice Address - Phone:573-335-1091
Practice Address - Fax:573-331-8453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO496-0282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
262015Medicare Oscar/Certification