Basic Information
Provider Information
NPI: 1437513686
EntityType: 2
ReplacementNPI:  
OrganizationName: FREEMAN NEOSHO HOSPITAL
LastName:  
FirstName:  
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NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
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Mailing Information
Address1: 1102 W 32ND ST
Address2:  
City: JOPLIN
State: MO
PostalCode: 648043503
CountryCode: US
TelephoneNumber: 4173471111
FaxNumber: 4173470702
Practice Location
Address1: 510 PARK ST
Address2:  
City: ANDERSON
State: MO
PostalCode: 648319280
CountryCode: US
TelephoneNumber: 4178450545
FaxNumber: 4178450548
Other Information
ProviderEnumerationDate: 04/13/2016
LastUpdateDate: 04/13/2016
NPIDeactivationReasonCode:  
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NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: GRADDY
AuthorizedOfficialFirstName: STEVEN
AuthorizedOfficialMiddleName: W
AuthorizedOfficialTitleorPosition: CFO
AuthorizedOfficialTelephone: 4173476678
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
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AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261QR1300X  Y Ambulatory Health Care FacilitiesClinic/CenterRural Health

No ID Information.


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