Provider Demographics
NPI:1437221074
Name:CEDAR COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:CEDAR COUNTY MEMORIAL HOSPITAL
Other - Org Name:CEDAR COUNTY MEMORIAL HOSPITAL IN HOME SERVICES AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANA
Authorized Official - Middle Name:C
Authorized Official - Last Name:WITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-876-2511
Mailing Address - Street 1:1317 S HIGHWAY 32
Mailing Address - Street 2:
Mailing Address - City:EL DORADO SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64744
Mailing Address - Country:US
Mailing Address - Phone:417-876-5477
Mailing Address - Fax:417-876-5017
Practice Address - Street 1:1317 S. HIGHWAY 32
Practice Address - Street 2:
Practice Address - City:EL DORADO SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64744
Practice Address - Country:US
Practice Address - Phone:417-876-5477
Practice Address - Fax:417-876-5017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO236-20251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO280325309Medicaid