Provider Demographics
NPI:1598873796
Name:FREEMAN NEOSHO HOSPITAL
Entity Type:Organization
Organization Name:FREEMAN NEOSHO HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:W
Authorized Official - Last Name:GRADDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-347-6678
Mailing Address - Street 1:1102 WEST 32ND STREET
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804
Mailing Address - Country:US
Mailing Address - Phone:417-347-1111
Mailing Address - Fax:417-347-0702
Practice Address - Street 1:113 W HICKORY ST
Practice Address - Street 2:
Practice Address - City:NEOSHO
Practice Address - State:MO
Practice Address - Zip Code:64850-1705
Practice Address - Country:US
Practice Address - Phone:417-347-1234
Practice Address - Fax:417-347-0702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO010323806Medicaid
MO32066OtherBLUE CHOICE
241760OtherHEALTHLINK
MO32162OtherBLUE CROSS BLUE SHIELD
KS200266700AOtherMEDICAID
MO540323805OtherMEDICAID
OK100712780FOtherMEDICAID
MO32066OtherBLUE CHOICE