Provider Demographics
NPI:1689124166
Name:MISSOURI BAPTIST HOSPITAL OF SULLIVAN
Entity Type:Organization
Organization Name:MISSOURI BAPTIST HOSPITAL OF SULLIVAN
Other - Org Name:MISSOURI BAPTIST CUBA MEDICAL OFFICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:L
Authorized Official - Last Name:SCHWARM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-468-4186
Mailing Address - Street 1:751 SAPPINGTON BRIDGE RD
Mailing Address - Street 2:ADMINISTRATION
Mailing Address - City:SULLIVAN
Mailing Address - State:MO
Mailing Address - Zip Code:63080-2354
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:102 OZARK DR STE B
Practice Address - Street 2:
Practice Address - City:CUBA
Practice Address - State:MO
Practice Address - Zip Code:65453-1664
Practice Address - Country:US
Practice Address - Phone:573-885-6600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-10
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty