Basic Information
Provider Information
NPI: 1689782872
EntityType: 2
ReplacementNPI:  
OrganizationName: FREEMAN NEOSHO HOSPITAL
LastName:  
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Mailing Information
Address1: 1102 WEST 32ND STREET
Address2:  
City: JOPLIN
State: MO
PostalCode: 64804
CountryCode: US
TelephoneNumber: 4173471111
FaxNumber: 4173470702
Practice Location
Address1: 113 W HICKORY ST
Address2:  
City: NEOSHO
State: MO
PostalCode: 648501705
CountryCode: US
TelephoneNumber: 4173471234
FaxNumber: 4173470702
Other Information
ProviderEnumerationDate: 08/28/2006
LastUpdateDate: 10/15/2009
NPIDeactivationReasonCode:  
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ProviderGenderCode:  
AuthorizedOfficialLastName: GRADDY
AuthorizedOfficialFirstName: STEVE
AuthorizedOfficialMiddleName: W
AuthorizedOfficialTitleorPosition: CFO
AuthorizedOfficialTelephone: 4173476678
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
282NC0060X  N HospitalsGeneral Acute Care HospitalCritical Access
275N00000X  Y Hospital UnitsMedicare Defined Swing Bed Unit 

No ID Information.


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