Provider Demographics
NPI:1548209794
Name:MACON COUNTY SAMARITAN HOSPITAL
Entity Type:Organization
Organization Name:MACON COUNTY SAMARITAN HOSPITAL
Other - Org Name:SAMARITAN HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:660-385-8716
Mailing Address - Street 1:1205 N MISSOURI ST
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:MO
Mailing Address - Zip Code:63552-2095
Mailing Address - Country:US
Mailing Address - Phone:660-385-8700
Mailing Address - Fax:660-385-8701
Practice Address - Street 1:1205 N MISSOURI ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:MO
Practice Address - Zip Code:63552-2095
Practice Address - Country:US
Practice Address - Phone:660-385-8700
Practice Address - Fax:660-385-8701
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MACON COUNTY SAMARITAN HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-05
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO643-7251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO267554Medicare Oscar/Certification