Provider Demographics
NPI:1518024553
Name:COMMUNITY MEMORIAL HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:COMMUNITY MEMORIAL HOSPITAL DISTRICT
Other - Org Name:MONTROSE RURAL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KADEENA
Authorized Official - Middle Name:
Authorized Official - Last Name:NITCHALS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-476-2121
Mailing Address - Street 1:100 W 4TH STREET
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:MO
Mailing Address - Zip Code:64770-9336
Mailing Address - Country:US
Mailing Address - Phone:660-693-8885
Mailing Address - Fax:660-693-8844
Practice Address - Street 1:100 W 4TH STREET
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:MO
Practice Address - Zip Code:64770-9336
Practice Address - Country:US
Practice Address - Phone:660-693-8885
Practice Address - Fax:660-693-8844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO598999001Medicaid
MO268594Medicare Oscar/Certification