Provider Demographics
NPI:1790972909
Name:BARTON COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:BARTON COUNTY MEMORIAL HOSPITAL
Other - Org Name:GOLDEN CITY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC BUSINESS COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:T
Authorized Official - Middle Name:J
Authorized Official - Last Name:KILLINGSWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-537-4311
Mailing Address - Street 1:407 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:GOLDEN CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64748
Mailing Address - Country:US
Mailing Address - Phone:417-537-4311
Mailing Address - Fax:417-537-4330
Practice Address - Street 1:407 MAIN STREET
Practice Address - Street 2:
Practice Address - City:GOLDEN CITY
Practice Address - State:MO
Practice Address - Zip Code:64748
Practice Address - Country:US
Practice Address - Phone:417-537-4311
Practice Address - Fax:417-537-4330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO101370207Q00000X
MO106158207VG0400X
MO105928207VG0400X
MO268625261QR1300X
MO086955363LF0000X
MO073423363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207607905Medicaid
MO1790972909Medicaid
MO1689717456OtherTHOMAS A. HOPKINS MD
MO428676829Medicaid
MO1790972909Medicare PIN
MO268625Medicare PIN
MO1790972909Medicaid
MO1689717456OtherTHOMAS A. HOPKINS MD
MO26-8625Medicare PIN
MO207607905Medicaid
MO1104853050Medicare PIN