Basic Information
| Provider Information | |||||||||
| NPI: | 1194783506 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FARMINGTON MISSOURI HOSPITAL COMPANY, LLC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | MINERAL AREA REGIONAL MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 1212 WEBER RD | ||||||||
| Address2: | |||||||||
| City: | FARMINGTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 636403325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5737564581 | ||||||||
| FaxNumber: | 5737565834 | ||||||||
| Practice Location | |||||||||
| Address1: | 1212 WEBER RD | ||||||||
| Address2: | |||||||||
| City: | FARMINGTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 636403325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5737564581 | ||||||||
| FaxNumber: | 5737565834 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2006 | ||||||||
| LastUpdateDate: | 01/15/2014 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | COFFEY | ||||||||
| AuthorizedOfficialFirstName: | S | ||||||||
| AuthorizedOfficialMiddleName: | RAY | ||||||||
| AuthorizedOfficialTitleorPosition: | VP, REIMBURSEMENT | ||||||||
| AuthorizedOfficialTelephone: | 6157643009 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | 319-14 | MO | N | Agencies | Home Health | 273R00000X | 184-46 | MO | N | Hospital Units | Psychiatric Unit | 275N00000X | 184-46 | MO | N | Hospital Units | Medicare Defined Swing Bed Unit | 282N00000X | 184-46 | MO | Y | Hospitals | General Acute Care Hospital |
No ID Information.