Provider Demographics
NPI:1851713580
Name:MOBERLY HOSPITAL COMPANY LLC
Entity Type:Organization
Organization Name:MOBERLY HOSPITAL COMPANY LLC
Other - Org Name:CHARITON VALLEY FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/DELEGATED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LALOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:629-215-3953
Mailing Address - Street 1:PO BOX 9645
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:MD
Mailing Address - Zip Code:04915-9022
Mailing Address - Country:US
Mailing Address - Phone:660-388-7084
Mailing Address - Fax:660-388-7087
Practice Address - Street 1:413 W 2ND ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MO
Practice Address - Zip Code:65281-1405
Practice Address - Country:US
Practice Address - Phone:660-388-7084
Practice Address - Fax:660-388-7087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-15
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO506-6261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PENDINGMedicare Oscar/Certification