Basic Information
| Provider Information | |||||||||
| NPI: | 1003824061 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PARKLAND HEALTH CENTER | ||||||||
| LastName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | PARKLAND HEALTH CENTER - FARMINGTON | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1101 W LIBERTY ST | ||||||||
| Address2: | |||||||||
| City: | FARMINGTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 636401921 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5737608280 | ||||||||
| FaxNumber: | 5737561408 | ||||||||
| Practice Location | |||||||||
| Address1: | 1101 W LIBERTY ST | ||||||||
| Address2: | |||||||||
| City: | FARMINGTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 636401921 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5737566451 | ||||||||
| FaxNumber: | 5737561408 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | SCHNABEL | ||||||||
| AuthorizedOfficialFirstName: | ANNETTE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5737608280 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 03/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 379-13 | MO | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 999681 | 01 | COMMUNITY CARE PLUS | OTHER | 260163 | 01 | MERCY MC | OTHER | 010638203 | 05 | MO | MEDICAID | 260163 | 01 | MERCY | OTHER | 856X8562 | 01 | HEALTHCARE USA | OTHER | 119 | 01 | BLUE CROSS-BLUE SHIELD | OTHER | 182901 | 01 | HEALTH LINK | OTHER | 5020035 | 01 | UNITED HEALTH CARE | OTHER |