Basic Information
| Provider Information | |||||||||
| NPI: | 1750776365 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PARKLAND HEALTH CENTER - WEBER ROAD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1101 W LIBERTY ST | ||||||||
| Address2: | ADMINISTRATION | ||||||||
| City: | FARMINGTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 636401921 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5737608280 | ||||||||
| FaxNumber: | 5737561408 | ||||||||
| Practice Location | |||||||||
| Address1: | 1212 WEBER RD | ||||||||
| Address2: | |||||||||
| City: | FARMINGTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 636403325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5737564581 | ||||||||
| FaxNumber: | 5737565834 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2015 | ||||||||
| LastUpdateDate: | 03/31/2015 | ||||||||
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| AuthorizedOfficialLastName: | KARL | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | P. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5737608275 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 509-7 | MO | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 10634806 | 05 | MO | MEDICAID |