Provider Demographics
NPI:1760501647
Name:ST. CLAIR COUNTY HOSPITAL DISTRICT #L
Entity Type:Organization
Organization Name:ST. CLAIR COUNTY HOSPITAL DISTRICT #L
Other - Org Name:TRI-COUNTY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALMA
Authorized Official - Middle Name:F
Authorized Official - Last Name:RODABAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-646-8181
Mailing Address - Street 1:700 GIESLER RD
Mailing Address - Street 2:P. O. BOX 426
Mailing Address - City:OSCEOLA
Mailing Address - State:MO
Mailing Address - Zip Code:64776-6279
Mailing Address - Country:US
Mailing Address - Phone:417-646-8181
Mailing Address - Fax:417-646-8153
Practice Address - Street 1:855 ARDUSER DR
Practice Address - Street 2:
Practice Address - City:OSCEOLA
Practice Address - State:MO
Practice Address - Zip Code:64776-6278
Practice Address - Country:US
Practice Address - Phone:417-646-8153
Practice Address - Fax:417-646-8515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0257260002Medicare ID - Type Unspecified