Provider Demographics
NPI:1710926928
Name:TEXAS COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:TEXAS COUNTY MEMORIAL HOSPITAL
Other - Org Name:TCMH PROFESSIONAL BUILDING-GENERAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:PAMPERIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-967-1255
Mailing Address - Street 1:1422 S SAM HOUSTON BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:MO
Mailing Address - Zip Code:65483-2130
Mailing Address - Country:US
Mailing Address - Phone:417-967-1252
Mailing Address - Fax:417-967-0417
Practice Address - Street 1:1422 S SAM HOUSTON BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:MO
Practice Address - Zip Code:65483-2130
Practice Address - Country:US
Practice Address - Phone:417-967-1252
Practice Address - Fax:417-967-0417
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TEXAS COUNTY MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-05
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO500253307Medicaid
MO500253307Medicaid
MO26D0889777OtherCLIA