Provider Demographics
NPI:1528208162
Name:COMMUNITY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:COMMUNITY MEMORIAL HOSPITAL
Other - Org Name:MONTROSE RURAL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:DELORES
Authorized Official - Middle Name:B
Authorized Official - Last Name:BRACHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-476-2121
Mailing Address - Street 1:PO BOX 64
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:MO
Mailing Address - Zip Code:64770-0064
Mailing Address - Country:US
Mailing Address - Phone:660-693-8885
Mailing Address - Fax:
Practice Address - Street 1:100 WEST 4TH ST
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:MO
Practice Address - Zip Code:64770
Practice Address - Country:US
Practice Address - Phone:660-693-8885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-23
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty