Provider Demographics
NPI:1467689398
Name:BATES COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:BATES COUNTY MEMORIAL HOSPITAL
Other - Org Name:FAMILY CARE CLINIC CHESTNUT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-200-7000
Mailing Address - Street 1:200 W CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:MO
Mailing Address - Zip Code:64730-1554
Mailing Address - Country:US
Mailing Address - Phone:660-200-7137
Mailing Address - Fax:660-200-7015
Practice Address - Street 1:200 W CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:MO
Practice Address - Zip Code:64730-1554
Practice Address - Country:US
Practice Address - Phone:660-200-7000
Practice Address - Fax:660-200-7015
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BATES COUNTY MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-18
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO29119207Q00000X
MO205-49261QR1300X
MO268639261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO6030000Medicare PIN
MO268639Medicare PIN