Provider Demographics
NPI:1922042704
Name:HANNIBAL REGIONAL HEALTHCARE SYSTEM, INC
Entity Type:Organization
Organization Name:HANNIBAL REGIONAL HEALTHCARE SYSTEM, INC
Other - Org Name:HANNIBAL REGIONAL HOSPITAL
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:J
Authorized Official - Last Name:DIX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-248-1300
Mailing Address - Street 1:6000 HOSPITAL DROVE
Mailing Address - Street 2:
Mailing Address - City:HANNIBAL
Mailing Address - State:MO
Mailing Address - Zip Code:63401-1257
Mailing Address - Country:US
Mailing Address - Phone:573-248-1300
Mailing Address - Fax:573-248-5264
Practice Address - Street 1:6000 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401-6887
Practice Address - Country:US
Practice Address - Phone:573-248-1300
Practice Address - Fax:573-248-5264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO101-48282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO540416005Medicaid
MO010416006Medicaid
MO260025Medicare Oscar/Certification
MO010416006Medicaid