Provider Demographics
NPI:1659700813
Name:CAMERON REGIONAL MEDICAL CENTER INC
Entity Type:Organization
Organization Name:CAMERON REGIONAL MEDICAL CENTER INC
Other - Org Name:EAGLEVILLE MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:F
Authorized Official - Last Name:ABRUTZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:816-649-3203
Mailing Address - Street 1:1600 E EVERGREEN ST
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:MO
Mailing Address - Zip Code:64429-2400
Mailing Address - Country:US
Mailing Address - Phone:816-632-2101
Mailing Address - Fax:816-649-3383
Practice Address - Street 1:12050 12TH ST
Practice Address - Street 2:
Practice Address - City:EAGLEVILLE
Practice Address - State:MO
Practice Address - Zip Code:64442-8158
Practice Address - Country:US
Practice Address - Phone:816-632-2101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO473-11261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health