Provider Demographics
NPI:1821089657
Name:SALEM MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:SALEM MEMORIAL HOSPITAL
Other - Org Name:SMDH FAMILY HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-729-6626
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MO
Mailing Address - Zip Code:65560-0069
Mailing Address - Country:US
Mailing Address - Phone:573-729-6112
Mailing Address - Fax:573-729-4035
Practice Address - Street 1:35629 HIGHWAY 72 BLDG II
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MO
Practice Address - Zip Code:65560-7217
Practice Address - Country:US
Practice Address - Phone:573-729-6112
Practice Address - Fax:573-729-4035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-01
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO596009506Medicaid
MO268654Medicare Oscar/Certification