Provider Demographics
NPI:1891757191
Name:SKAGGS COMMUNITY HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:SKAGGS COMMUNITY HOSPITAL ASSOCIATION
Other - Org Name:COXHEALTH OXFORD HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:K
Authorized Official - Last Name:MAHONEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-335-7350
Mailing Address - Street 1:590 BIRCH RD
Mailing Address - Street 2:STE. 1C
Mailing Address - City:HOLLISTER
Mailing Address - State:MO
Mailing Address - Zip Code:65672-9605
Mailing Address - Country:US
Mailing Address - Phone:417-348-8500
Mailing Address - Fax:417-348-8510
Practice Address - Street 1:590 BIRCH RD
Practice Address - Street 2:STE. 1C
Practice Address - City:HOLLISTER
Practice Address - State:MO
Practice Address - Zip Code:65672-9607
Practice Address - Country:US
Practice Address - Phone:417-348-8500
Practice Address - Fax:417-348-8510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-04
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO919251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO580932507Medicaid
MO267192Medicare Oscar/Certification