Provider Demographics
| NPI: | 1679517023 |
|---|---|
| Name: | FREEMAN-OAK HILL HEALTH SYSTEM |
| Entity Type: | Organization |
| Organization Name: | FREEMAN-OAK HILL HEALTH SYSTEM |
| Other - Org Name: | FREEMAN PHYSICIAN GROUP |
| Other - Org Type: | Doing Business As |
| Authorized Official - Title/Position: | CFO |
| Authorized Official - Prefix: | MR |
| Authorized Official - First Name: | STEVE |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | GRADDY |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 417-347-1111 |
| Mailing Address - Street 1: | PO BOX 3810 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | JOPLIN |
| Mailing Address - State: | MO |
| Mailing Address - Zip Code: | 64803-3810 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 417-347-6605 |
| Mailing Address - Fax: | 417-347-9106 |
| Practice Address - Street 1: | 1102 W 32ND ST |
| Practice Address - Street 2: | |
| Practice Address - City: | JOPLIN |
| Practice Address - State: | MO |
| Practice Address - Zip Code: | 64804-3503 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 417-347-6605 |
| Practice Address - Fax: | 417-347-9106 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2006-06-16 |
| Last Update Date: | 2020-08-04 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 261QM1300X | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | Group - Multi-Specialty |
| No | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology | Group - Multi-Specialty | |
| No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
| No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
| No | 207T00000X | Allopathic & Osteopathic Physicians | Neurological Surgery | Group - Multi-Specialty | |
| No | 207U00000X | Allopathic & Osteopathic Physicians | Nuclear Medicine | Group - Multi-Specialty | |
| No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
| No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
| No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
| No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty | |
| No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
| No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
| No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
| No | 208G00000X | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| KS | 100099600K | Medicaid | |
| KS | CJ9325 | Other | RR MEDICARE |
| KS | 100099600J | Medicaid | |
| MO | CD6111 | Other | RR MEDICARE |
| KS | 110134 | Other | KS BCBS |
| KS | 100099600H | Medicaid | |
| KS | CJ9325 | Other | RR MEDICARE |
| 000013108 | Medicare PIN | ||
| KS | 110134 | Medicare PIN | |
| MO | 990001464 | Medicare PIN | |
| MO | 000011581 | Medicare PIN | |
| MO | 000013525 | Medicare PIN | |
| MO | 000013657 | Medicare PIN | |
| KS | 110134 | Other | KS BCBS |
| KS | 100099600K | Medicaid | |
| KS | 100099600J | Medicaid | |
| KS | 100099600H | Medicaid | |
| MO | 990001433 | Medicare PIN |
