Provider Demographics
NPI:1972731529
Name:CARROLL COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:CARROLL COUNTY MEMORIAL HOSPITAL
Other - Org Name:REID MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:TINDLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-542-1695
Mailing Address - Street 1:1401 N JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:MO
Mailing Address - Zip Code:64633-1945
Mailing Address - Country:US
Mailing Address - Phone:660-542-3900
Mailing Address - Fax:660-542-3902
Practice Address - Street 1:1401 N JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:MO
Practice Address - Zip Code:64633-1945
Practice Address - Country:US
Practice Address - Phone:660-542-3900
Practice Address - Fax:660-542-3902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-22
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
268670Medicare Oscar/Certification