Provider Demographics
NPI:1891734505
Name:MACON COUNTY SAMARITAN HOSPITAL
Entity Type:Organization
Organization Name:MACON COUNTY SAMARITAN HOSPITAL
Other - Org Name:TOTAL FAMILY HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:660-385-8716
Mailing Address - Street 1:1205 N MISSOURI ST
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:MO
Mailing Address - Zip Code:63552-2095
Mailing Address - Country:US
Mailing Address - Phone:660-385-8700
Mailing Address - Fax:660-385-8701
Practice Address - Street 1:1201 N RUTHERFORD ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:MO
Practice Address - Zip Code:63552-2020
Practice Address - Country:US
Practice Address - Phone:660-385-8900
Practice Address - Fax:660-385-8708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
N/A - HOSPITAL BASED261QC0050X, 261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261QC0050XAmbulatory Health Care FacilitiesClinic/CenterCritical Access Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO596088104Medicaid
MO505973701OtherMEDICAID MO
MODA1450OtherRAILROAD MEDICARE
MO000013920OtherMEDICARE MO
MO505973701OtherMEDICAID MO