Provider Demographics
NPI:1841579356
Name:HANNIBAL REGIONAL HOSPITAL
Entity Type:Organization
Organization Name:HANNIBAL REGIONAL HOSPITAL
Other - Org Name:HANNIBAL REGIONAL MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DIX
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-248-1300
Mailing Address - Street 1:101 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62363-1436
Mailing Address - Country:US
Mailing Address - Phone:217-285-5012
Mailing Address - Fax:217-285-4519
Practice Address - Street 1:101 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:IL
Practice Address - Zip Code:62363-1436
Practice Address - Country:US
Practice Address - Phone:217-285-5012
Practice Address - Fax:217-285-4519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-15
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier