Basic Information
| Provider Information | |||||||||
| NPI: | 1841307428 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FREEMAN NEOSHO HOSPITAL | ||||||||
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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: | 113 W HICKORY ST | ||||||||
| Address2: | |||||||||
| City: | NEOSHO | ||||||||
| State: | MO | ||||||||
| PostalCode: | 648501705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4174511234 | ||||||||
| FaxNumber: | 4173470702 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2006 | ||||||||
| LastUpdateDate: | 10/15/2009 | ||||||||
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| AuthorizedOfficialLastName: | GRADDY | ||||||||
| AuthorizedOfficialFirstName: | STEVEN | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 4173476678 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC0060X | Y | Hospitals | General Acute Care Hospital | Critical Access |
ID Information
| ID | Type | State | Issuer | Description | 32066 | 01 | BLUE CHOICE | OTHER | 540323805 | 05 | MO | MEDICAID | 241760 | 01 | HEALTHLINK | OTHER |