Provider Demographics
NPI:1952557399
Name:CARROLL COUNTY HOSPITAL PHTYSICIANS
Entity type:Organization
Organization Name:CARROLL COUNTY HOSPITAL PHTYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:IRELAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-542-1695
Mailing Address - Street 1:1502 N JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:MO
Mailing Address - Zip Code:64633-1948
Mailing Address - Country:US
Mailing Address - Phone:660-542-1695
Mailing Address - Fax:660-542-0363
Practice Address - Street 1:1502 N JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:MO
Practice Address - Zip Code:64633-1948
Practice Address - Country:US
Practice Address - Phone:660-542-1695
Practice Address - Fax:660-542-0363
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARROLL COUNTY MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-18
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO21047282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO540157906Medicaid
MO7910000Medicare Oscar/Certification