Provider Demographics
NPI:1922345800
Name:SALEM MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:SALEM MEMORIAL HOSPITAL
Other - Org Name:SMDH CENTER FOR FAMILY HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-729-5917
Mailing Address - Street 1:PO BOX 680
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MO
Mailing Address - Zip Code:65560-0680
Mailing Address - Country:US
Mailing Address - Phone:573-729-5917
Mailing Address - Fax:573-739-4759
Practice Address - Street 1:35629 HIGHWAY 72
Practice Address - Street 2:BUILDING 1
Practice Address - City:SALEM
Practice Address - State:MO
Practice Address - Zip Code:65560-7217
Practice Address - Country:US
Practice Address - Phone:573-729-5917
Practice Address - Fax:573-739-4759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-11
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007013987207Q00000X
261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty