Provider Demographics
NPI:1891766051
Name:PHELPS COUNTY REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:PHELPS COUNTY REGIONAL MEDICAL CENTER
Other - Org Name:PHELPS HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:SHENEFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-458-7975
Mailing Address - Street 1:PO BOX 220
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65402-0220
Mailing Address - Country:US
Mailing Address - Phone:573-458-8899
Mailing Address - Fax:
Practice Address - Street 1:1000 W 10TH ST
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-2905
Practice Address - Country:US
Practice Address - Phone:573-458-8899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-27
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1447282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO010419109Medicaid
MO60171Medicare ID - Type UnspecifiedMEDICARE PART B CRNA
MOCS2462Medicare ID - Type UnspecifiedRR MEDICARE GROUP
MO260017Medicare ID - Type Unspecified
MO010419109Medicaid
MO50080Medicare ID - Type UnspecifiedPART B PHYSICIAN GROUP