Provider Demographics
NPI:1568456283
Name:BREECH REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:BREECH REGIONAL MEDICAL CENTER
Other - Org Name:ST. JOHN'S HOSPITAL - LEBANON, HOME MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BOARD CHAIR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:E
Authorized Official - Last Name:WILHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-532-3177
Mailing Address - Street 1:100 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:MO
Mailing Address - Zip Code:65536-9210
Mailing Address - Country:US
Mailing Address - Phone:417-588-9330
Mailing Address - Fax:417-588-9330
Practice Address - Street 1:594 OLD ROUTE 66
Practice Address - Street 2:
Practice Address - City:ST ROBERT
Practice Address - State:MO
Practice Address - Zip Code:65584-3729
Practice Address - Country:US
Practice Address - Phone:573-336-4111
Practice Address - Fax:573-336-4210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004029016332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO4231150002Medicare ID - Type Unspecified