Provider Demographics
NPI:1467557488
Name:PERRY COUNTY HEALTH SYSTEM
Entity Type:Organization
Organization Name:PERRY COUNTY HEALTH SYSTEM
Other - Org Name:PERRYVILLE FAMILY CARE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:REITZEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-547-7888
Mailing Address - Street 1:212 HOSPITAL LN
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PERRYVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63775-1276
Mailing Address - Country:US
Mailing Address - Phone:573-547-7888
Mailing Address - Fax:573-547-5481
Practice Address - Street 1:212 HOSPITAL LN
Practice Address - Street 2:SUITE 101
Practice Address - City:PERRYVILLE
Practice Address - State:MO
Practice Address - Zip Code:63775-1276
Practice Address - Country:US
Practice Address - Phone:573-547-7888
Practice Address - Fax:573-547-5481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO597917103Medicaid
MO503318800Medicaid
MO503318800Medicaid
MO000014800Medicare PIN