Provider Demographics
NPI:1487821179
Name:FREEMAN-OAK HILL HEALTH SYSTEM
Entity Type:Organization
Organization Name:FREEMAN-OAK HILL HEALTH SYSTEM
Other - Org Name:FREEMAN MATERNITY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/VP
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:P
Authorized Official - Last Name:GAUDETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-347-6605
Mailing Address - Street 1:PO BOX 3810
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64803-3810
Mailing Address - Country:US
Mailing Address - Phone:417-347-8566
Mailing Address - Fax:
Practice Address - Street 1:3401 MC INTOSH CIR STE 101
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-3604
Practice Address - Country:US
Practice Address - Phone:417-347-8566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-12
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO188674907Medicaid