Basic Information
| Provider Information | |||||||||
| NPI: | 1598710097 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CAH ACQUISITION COMPANY 6 LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | I 70 COMMUNITY HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 105 HOSPITAL DRIVE | ||||||||
| Address2: | |||||||||
| City: | SWEET SPRINGS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 653512229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6603354700 | ||||||||
| FaxNumber: | 6603357478 | ||||||||
| Practice Location | |||||||||
| Address1: | 105 HOSPITAL DRIVE | ||||||||
| Address2: | |||||||||
| City: | SWEET SPRINGS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 653512229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6603354700 | ||||||||
| FaxNumber: | 6603357478 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2006 | ||||||||
| LastUpdateDate: | 10/05/2010 | ||||||||
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| AuthorizedOfficialLastName: | DAVENPORT | ||||||||
| AuthorizedOfficialFirstName: | JULIE | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 6603357408 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NR1301X | 493-0 | MO | N | Hospitals | General Acute Care Hospital | Rural | 282NC0060X | 493-0 | MO | Y | Hospitals | General Acute Care Hospital | Critical Access |
ID Information
| ID | Type | State | Issuer | Description | 540956901 | 05 | MO | MEDICAID | 91264016 | 01 | MO | BC PROVIDER NUMBER | OTHER | 016238107 | 05 | MO | MEDICAID |