1326108226 NPI number — DEXTER HOSPITAL LLC

Table of content: (NPI 1326108226)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326108226 NPI number — DEXTER HOSPITAL LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEXTER HOSPITAL LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MSH INTERNAL MEDICINE OF BLOOMFIELD
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326108226
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 368
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEXTER
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63841
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-624-3165
Provider Business Mailing Address Fax Number:
573-624-3157

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1003 HIGHWAY 25 NORTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLOOMFIELD
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63825
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-568-3686
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
SUE ANN
Authorized Official Middle Name:
Authorized Official Title or Position:
CLINIC ADMINISTRATOR
Authorized Official Telephone Number:
573-624-1640

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: DC5318 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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