Provider Demographics
NPI:1295970945
Name:COMMUNITY MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:COMMUNITY MEMORIAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SR. BILLING CLERK
Authorized Official - Prefix:
Authorized Official - First Name:DELORES
Authorized Official - Middle Name:B
Authorized Official - Last Name:BRACHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-476-2121
Mailing Address - Street 1:PO BOX 570
Mailing Address - Street 2:
Mailing Address - City:OSCEOLA
Mailing Address - State:MO
Mailing Address - Zip Code:64776-0570
Mailing Address - Country:US
Mailing Address - Phone:417-646-8123
Mailing Address - Fax:
Practice Address - Street 1:101 GIESLER DR
Practice Address - Street 2:
Practice Address - City:OSCEOLA
Practice Address - State:MO
Practice Address - Zip Code:64776-6297
Practice Address - Country:US
Practice Address - Phone:417-646-8123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-10
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty