Provider Demographics
NPI:1982931820
Name:CAMERON REGIONAL MEDICAL CENTER INC
Entity Type:Organization
Organization Name:CAMERON REGIONAL MEDICAL CENTER INC
Other - Org Name:RENAL DIALYSIS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:F
Authorized Official - Last Name:ABRUTZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:816-632-2101
Mailing Address - Street 1:1600 E EVERGREEN ST
Mailing Address - Street 2:MP III STE A
Mailing Address - City:CAMERON
Mailing Address - State:MO
Mailing Address - Zip Code:64429-2400
Mailing Address - Country:US
Mailing Address - Phone:816-632-2101
Mailing Address - Fax:816-649-3383
Practice Address - Street 1:1600 E EVERGREEN ST
Practice Address - Street 2:MP III STE A
Practice Address - City:CAMERON
Practice Address - State:MO
Practice Address - Zip Code:64429-2400
Practice Address - Country:US
Practice Address - Phone:816-649-3398
Practice Address - Fax:816-649-3379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-13
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO47372472R0900X
261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
No2472R0900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherRenal DialysisGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOPENDINGMedicare Oscar/Certification