Provider Demographics
NPI:1568692788
Name:WASHINGTON COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:WASHINGTON COUNTY MEMORIAL HOSPITAL
Other - Org Name:POTOSI RURAL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:PRATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-438-5451
Mailing Address - Street 1:300 HEALTH WAY DR
Mailing Address - Street 2:
Mailing Address - City:POTOSI
Mailing Address - State:MO
Mailing Address - Zip Code:63664-1420
Mailing Address - Country:US
Mailing Address - Phone:573-438-5451
Mailing Address - Fax:573-438-2399
Practice Address - Street 1:1 KWAN PLAZA HIGHWAY 8 E
Practice Address - Street 2:
Practice Address - City:POTOSI
Practice Address - State:MO
Practice Address - Zip Code:63664-1435
Practice Address - Country:US
Practice Address - Phone:573-438-1899
Practice Address - Fax:573-438-1898
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WASHINGTON COUNTY MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-22
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO594401804Medicaid
MO010780609Medicaid