Provider Demographics
NPI:1881667095
Name:SALEM MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:SALEM MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR HOME HEALTH AGENCY
Authorized Official - Prefix:MS
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:E
Authorized Official - Last Name:RADFORD
Authorized Official - Suffix:
Authorized Official - Credentials:BSN MSHCA
Authorized Official - Phone:573-729-6626
Mailing Address - Street 1:PO BOX 774
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MO
Mailing Address - Zip Code:65560-0774
Mailing Address - Country:US
Mailing Address - Phone:573-729-6626
Mailing Address - Fax:573-739-1294
Practice Address - Street 1:35629 HIGHWAY 72
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:573-729-6626
Practice Address - Fax:573-739-1294
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SALEM MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-08
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO21719163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO582157806Medicaid
MO582157806Medicaid