Provider Demographics
NPI:1518174507
Name:COMMUNITY HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:COMMUNITY HOSPITAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-686-2321
Mailing Address - Street 1:26136 US HIGHWAY 59
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:MO
Mailing Address - Zip Code:64446-9105
Mailing Address - Country:US
Mailing Address - Phone:660-686-2328
Mailing Address - Fax:660-686-2618
Practice Address - Street 1:514 STATE ST
Practice Address - Street 2:
Practice Address - City:MOUND CITY
Practice Address - State:MO
Practice Address - Zip Code:64470-1145
Practice Address - Country:US
Practice Address - Phone:660-442-3181
Practice Address - Fax:660-686-2618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201280609Medicaid
MO08481-016OtherBLUE CROSS GROUP NUMBER
MOMO40000Medicare Oscar/Certification