Basic Information
| Provider Information | |||||||||
| NPI: | 1477648178 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | IRON COUNTY HOSPITAL DISTRICT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 548 | ||||||||
| Address2: | 301 NORTH HWY 21 | ||||||||
| City: | PILOT KNOB | ||||||||
| State: | MO | ||||||||
| PostalCode: | 63663 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5735461260 | ||||||||
| FaxNumber: | 5735468088 | ||||||||
| Practice Location | |||||||||
| Address1: | 301 N HIGHWAY 21 | ||||||||
| Address2: | |||||||||
| City: | PILOT KNOB | ||||||||
| State: | MO | ||||||||
| PostalCode: | 636630548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5735461260 | ||||||||
| FaxNumber: | 5735468088 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2006 | ||||||||
| LastUpdateDate: | 03/29/2018 | ||||||||
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| AuthorizedOfficialLastName: | FARLEY | ||||||||
| AuthorizedOfficialFirstName: | SHANNON | ||||||||
| AuthorizedOfficialMiddleName: | LEE | ||||||||
| AuthorizedOfficialTitleorPosition: | BUSINESS OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5735468001 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC0060X | N | Hospitals | General Acute Care Hospital | Critical Access | 282NC0060X | 501-1 | MO | N | Hospitals | General Acute Care Hospital | Critical Access | 282NC0060X | 501-4 | MO | Y | Hospitals | General Acute Care Hospital | Critical Access |
ID Information
| ID | Type | State | Issuer | Description | 019899608 | 05 | MO | MEDICAID |