Provider Demographics
NPI:1598945867
Name:COMMUNITY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:COMMUNITY MEMORIAL HOSPITAL
Other - Org Name:MORTON VANZANTEN RURAL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:TADLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-646-8123
Mailing Address - Street 1:101 GIESLER DR
Mailing Address - Street 2:PO BOX 570
Mailing Address - City:OSCEOLA
Mailing Address - State:MO
Mailing Address - Zip Code:64776-6297
Mailing Address - Country:US
Mailing Address - Phone:417-646-8123
Mailing Address - Fax:417-646-8911
Practice Address - Street 1:101 GIESLER DR
Practice Address - Street 2:
Practice Address - City:OSCEOLA
Practice Address - State:MO
Practice Address - Zip Code:64776-6297
Practice Address - Country:US
Practice Address - Phone:417-646-8123
Practice Address - Fax:417-646-8911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO27033261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health