Provider Demographics
NPI:1518904531
Name:TEXAS COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:TEXAS COUNTY MEMORIAL HOSPITAL
Other - Org Name:TCMH FAMILY CLINIC & INTERNAL MEDICINE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:PAMPERIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-967-3311
Mailing Address - Street 1:1337 S SAM HOUSTON BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:MO
Mailing Address - Zip Code:65483-2046
Mailing Address - Country:US
Mailing Address - Phone:417-967-5435
Mailing Address - Fax:417-967-5503
Practice Address - Street 1:500 MAIN STREET
Practice Address - Street 2:
Practice Address - City:CABOOL
Practice Address - State:MO
Practice Address - Zip Code:65689
Practice Address - Country:US
Practice Address - Phone:417-962-3015
Practice Address - Fax:417-962-5938
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TEXAS COUNTY MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-31
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO509319208Medicaid
MO26D1006457OtherCLIA
MO000013676Medicare PIN