Basic Information
| Provider Information | |||||||||
| NPI: | 1285669432 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CAMERON REGIONAL MEDICAL CENTER INC | ||||||||
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| OtherOrganizationName: | COMFORT CARE HOSPICE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1600 E EVERGREEN ST | ||||||||
| Address2: | PO BOX 557 | ||||||||
| City: | CAMERON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 644292400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8166322101 | ||||||||
| FaxNumber: | 8166493383 | ||||||||
| Practice Location | |||||||||
| Address1: | 1005 W 3RD ST | ||||||||
| Address2: | SUITE 4 | ||||||||
| City: | CAMERON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 644291415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8166324411 | ||||||||
| FaxNumber: | 8166324505 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2006 | ||||||||
| LastUpdateDate: | 03/26/2012 | ||||||||
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| AuthorizedOfficialLastName: | ABRUTZ | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
| AuthorizedOfficialMiddleName: | F | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8166322101 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | 004-9HO | MO | Y | Agencies | Hospice Care, Community Based |
ID Information
| ID | Type | State | Issuer | Description | 820636108 | 05 | MO | MEDICAID |