Provider Demographics
NPI:1770536740
Name:BATES COUNTY MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:BATES COUNTY MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-200-7000
Mailing Address - Street 1:PO BOX 19793
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4092
Mailing Address - Country:US
Mailing Address - Phone:660-200-7000
Mailing Address - Fax:660-200-7004
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:660-200-7004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO268646261Q00000X, 261QR1300X
MO268606261Q00000X, 261QR1300X
MO268639261Q00000X, 261QR1300X
MO205 45282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO540673605Medicaid
MO00125012OtherKC BC/BS
MO010673606Medicaid
MO90012015OtherKC BC/BS
MO0927601OtherKC BC/BS
MO588185306Medicaid
MO800673618Medicaid
KS8030343401Medicaid
MO0927601OtherKC BC/BS
MO800673618Medicaid
MO268646Medicare PIN
MO260034Medicare PIN
260034Medicare Oscar/Certification
MO6030000Medicare PIN
MO268639Medicare PIN