Provider Demographics
NPI:1740311471
Name:BATES COUNTY MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:BATES COUNTY MEMORIAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:A
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-200-7000
Mailing Address - Street 1:615 W NURSERY ST
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:MO
Mailing Address - Zip Code:64730-1840
Mailing Address - Country:US
Mailing Address - Phone:660-200-7000
Mailing Address - Fax:660-200-7015
Practice Address - Street 1:615 W NURSERY ST
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:MO
Practice Address - Zip Code:64730-1840
Practice Address - Country:US
Practice Address - Phone:660-200-7000
Practice Address - Fax:660-200-7015
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BATES COUNTY MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-07
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000165893208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO540673605Medicaid
MO37710014OtherBLUE CROSS BLUE SHIELD
MO6030000OtherMEDICARE
MO6030000OtherMEDICARE
MO540673605Medicaid
MO6030000Medicare Oscar/Certification
MO603F381Medicare Oscar/Certification