Provider Demographics
NPI:1295743169
Name:MISSOURI BAPTIST HOSPITAL OF SULLIVAN
Entity type:Organization
Organization Name:MISSOURI BAPTIST HOSPITAL OF SULLIVAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHWARM
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:573-468-1343
Mailing Address - Street 1:751 SAPPINGTON BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN
Mailing Address - State:MO
Mailing Address - Zip Code:63080-2354
Mailing Address - Country:US
Mailing Address - Phone:573-468-1343
Mailing Address - Fax:573-860-2696
Practice Address - Street 1:751 SAPPINGTON BRIDGE RD
Practice Address - Street 2:
Practice Address - City:SULLIVAN
Practice Address - State:MO
Practice Address - Zip Code:63080-2354
Practice Address - Country:US
Practice Address - Phone:573-468-4186
Practice Address - Fax:573-860-2696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
163W00000X, 207Q00000X, 261QC0050X, 341600000X, 282NC0060X
MO355-24282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QC0050XAmbulatory Health Care FacilitiesClinic/CenterCritical Access Hospital
No282N00000XHospitalsGeneral Acute Care Hospital
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
260115OtherPREMIER PLUS
MO800565004Medicaid
MOMI010565000Medicaid
108OtherBLUE CHOICE
489665OtherAETNA
MO540565009Medicaid
MOCG2664OtherMEDICARE RAILROAD
MOCE7443OtherMEDICARE RAILROAD
108OtherBLUE CROSS-BLUE SHIELD
=========OtherHEALTHCARE USA
MOCE7443OtherMEDICARE RAILROAD
260115OtherPREMIER PLUS
=========OtherMERCY
=========OtherHEALTHLINK
=========OtherCIGNA
108OtherBLUE CROSS-BLUE SHIELD
MOMI010565000Medicaid