Provider Demographics
NPI:1740427889
Name:PERRY COUNTY HEALTH SYSTEM
Entity Type:Organization
Organization Name:PERRY COUNTY HEALTH SYSTEM
Other - Org Name:PERRYVILLE SURGICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/ CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-547-2536
Mailing Address - Street 1:212 HOSPITAL LN
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PERRYVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63775-1276
Mailing Address - Country:US
Mailing Address - Phone:573-547-8390
Mailing Address - Fax:573-547-6238
Practice Address - Street 1:212 HOSPITAL LN
Practice Address - Street 2:SUITE 202
Practice Address - City:PERRYVILLE
Practice Address - State:MO
Practice Address - Zip Code:63775-1276
Practice Address - Country:US
Practice Address - Phone:573-547-8390
Practice Address - Fax:573-547-6238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-12
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty