Basic Information
Provider Information | |||||||||
NPI: | 1184864779 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | CAH ACQUISITION COMPANY 6 LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | I-70 COMMUNITY HOSPITAL | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 105 HOSPITAL DRIVE | ||||||||
Address2: |   | ||||||||
City: | SWEET SPRINGS | ||||||||
State: | MO | ||||||||
PostalCode: | 653512229 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6603354700 | ||||||||
FaxNumber: | 6603357487 | ||||||||
Practice Location | |||||||||
Address1: | 105 HOSPITAL DRIVE | ||||||||
Address2: |   | ||||||||
City: | SWEET SPRINGS | ||||||||
State: | MO | ||||||||
PostalCode: | 65351 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6603354700 | ||||||||
FaxNumber: | 6603357487 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/23/2009 | ||||||||
LastUpdateDate: | 01/16/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | MCCUTCHEON | ||||||||
AuthorizedOfficialFirstName: | JENNIFER | ||||||||
AuthorizedOfficialMiddleName: | L | ||||||||
AuthorizedOfficialTitleorPosition: | CEO | ||||||||
AuthorizedOfficialTelephone: | 6603354700 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 275N00000X |   |   | N |   | Hospital Units | Medicare Defined Swing Bed Unit |   | 282NC0060X |   |   | N |   | Hospitals | General Acute Care Hospital | Critical Access | 261QC0050X |   |   | Y |   | Ambulatory Health Care Facilities | Clinic/Center | Critical Access Hospital |
ID Information
ID | Type | State | Issuer | Description | MA2024 | 01 | MO | MEDICARE PTAN - PART B | OTHER |