Provider Demographics
NPI:1629276209
Name:SCOTLAND COUNTY MEMORIAL HOSPITAL DBA LANCASTER MEDICAL SERVICES
Entity Type:Organization
Organization Name:SCOTLAND COUNTY MEMORIAL HOSPITAL DBA LANCASTER MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:R
Authorized Official - Last Name:DIAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-465-8511
Mailing Address - Street 1:RR 1 BOX 54
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:MO
Mailing Address - Zip Code:63555-9788
Mailing Address - Country:US
Mailing Address - Phone:660-465-2828
Mailing Address - Fax:660-465-2820
Practice Address - Street 1:HWY 63 N
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:MO
Practice Address - Zip Code:63548
Practice Address - Country:US
Practice Address - Phone:660-457-3655
Practice Address - Fax:660-457-3656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-05
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO505327205Medicaid
MO000013385Medicare PIN
MO000013385Medicare Oscar/Certification