Provider Demographics
NPI:1619921160
Name:PERRY COUNTY HEALTH SYSTEM
Entity Type:Organization
Organization Name:PERRY COUNTY HEALTH SYSTEM
Other - Org Name:PERRY COUNTY PHYSICIAN SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-547-2536
Mailing Address - Street 1:206 HOSPITAL LANE
Mailing Address - Street 2:
Mailing Address - City:PERRYVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63775-1382
Mailing Address - Country:US
Mailing Address - Phone:573-547-4899
Mailing Address - Fax:573-547-5388
Practice Address - Street 1:206 HOSPITAL LN
Practice Address - Street 2:
Practice Address - City:PERRYVILLE
Practice Address - State:MO
Practice Address - Zip Code:63775-1276
Practice Address - Country:US
Practice Address - Phone:573-547-4899
Practice Address - Fax:573-547-5388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO505251108Medicaid
MO505251108Medicaid
MO000013371Medicare PIN