Provider Demographics
NPI:1972607414
Name:WASHINGTON COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:WASHINGTON COUNTY MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:
Authorized Official - Last Name:OSBAHR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-438-5451
Mailing Address - Street 1:14 KWAN PLZ
Mailing Address - Street 2:
Mailing Address - City:POTOSI
Mailing Address - State:MO
Mailing Address - Zip Code:63664-1435
Mailing Address - Country:US
Mailing Address - Phone:573-438-7901
Mailing Address - Fax:573-438-6179
Practice Address - Street 1:14 KWAN PLZ
Practice Address - Street 2:
Practice Address - City:POTOSI
Practice Address - State:MO
Practice Address - Zip Code:63664-1435
Practice Address - Country:US
Practice Address - Phone:573-438-7901
Practice Address - Fax:573-438-6179
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WASHINGTON COUNTY MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-12
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO39-21163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO580780609Medicaid
MO267139Medicare Oscar/Certification