WASHINGTON COUNTY MEMORIAL HOSPITAL (NPI# 1720349970) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720349970 |
| Entity Type | Organization |
| Organization Name | WASHINGTON COUNTY MEMORIAL HOSPITAL |
| Other Organization Name | BONNE TERRE MEDICAL GROUP |
| Practice Address |
527 Benham St Bonne Terre MO 63628-1205 |
| Mailing Address |
300 Health Way Dr Potosi MO 63664-1420 |
| Practice Telephone | 5733585577 |
| Practice Fax Number | 5733584435 |
| Mailing Telephone | 5734385451 |
| Mailing Fax Number | 5734382399 |
| Enumeration Date | 2012-06-05 |
| Last Update Date | 2014-12-22 |
| Authorized Official Name | MR. KENNETH F MARX (INTERIM CEO) |
| Authorized Official Telephone | 5734385451 |
| Is Organization Subpart | Y |
| Parent Organization Name | WASHINGTON COUNTY MEMORIAL HOSPITAL |
| Parent Organization TIN |
|
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR1300X |
Clinic/Center Specialization: Rural Health |
MO | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| BONNE TERRE MEDICAL GROUP | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871102137 | Washington County Memorial Hospital | Clinic/Center | 14206 Hwy C, Belgrade, MO 63622 | 2020-07-23 |
| 1366713034 | Washington County Memorial Hospital | Clinic/Center | 1311 Maple St, Farmington, MO 63640-7641 | 2012-01-26 |
| 1568692788 | Washington County Memorial Hospital | Clinic/Center | 1 Kwan Plaza Highway 8 E, Potosi, MO 63664-1435 | 2009-07-22 |
| 1598826752 | Washington County Memorial Hospital | Radiologic Technologist | 125 Spring Meadow Cir, Salem, IN 47167-9429 | 2006-12-12 |
| 1972607414 | Washington County Memorial Hospital | Registered Nurse | 14 Kwan Plz, Potosi, MO 63664-1435 | 2006-09-12 |
| 1104933837 | Washington County Memorial Hospital | Family Medicine | 108 Frizzell St Ste 5, Potosi, MO 63664-1593 | 2006-08-25 |
| 1124062419 | Washington County Memorial Hospital | Anesthesiology | 911 N. Shelby St., Salem, IN 47167-2304 | 2006-06-16 |
| 1467424788 | Washington County Memorial Hospital | Clinic/Center | 108 Frizzell Street, Potosi, MO 63664 | 2006-02-02 |
| 1891149415 | Washington County Memorial Hospital | Clinic/Center | 200 Health Way Dr, Potosi, MO 63664-1434 | 2016-04-20 |
| 1205064532 | Washington County Memorial Hospital | Clinic/Center | 300 Health Way Dr, Potosi, MO 63664-1420 | 2009-06-25 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | WASHINGTON COUNTY MEMORIAL HOSPITAL | 300 Health Way, Potosi, MO 63664-1420 |
| Street Address |
527 BENHAM ST |
| City | BONNE TERRE |
| State | MO |
| Zip Code | 63628-1205 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427045004 | Pairat Vibulakaopun | Internal Medicine | 527 Benham St, Bonne Terre, MO 63628-1205 | 2005-09-29 |
| 1669017315 | Patricia Ann Peterson | Nurse Practitioner | 527 Benham St, Bonne Terre, MO 63628-1205 | 2019-11-15 |
| 1225562077 | Ronay Rodgers | Nurse Practitioner | 527 Benham St, Bonne Terre, MO 63628-1205 | 2017-04-19 |
| 1962883751 | Primary Care of Bonne Terre LLC | Clinic/Center | 527 Benham St, Bonne Terre, MO 63628-1205 | 2015-06-17 |
| 1609841956 | Andrew John Ninichuck | General Practice | 527 Benham St, Bonne Terre, MO 63628-1205 | 2006-02-21 |
| 1891767125 | Constance L Young | Nurse Practitioner | 527 Benham St, Bonne Terre, MO 63628-1205 | 2006-02-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437675477 | Kybama, Inc | Residential Treatment Facility, Emotionally Disturbed Children | 12729 Stoney Point Rd, Bonne Terre, MO 63628 | 2017-08-22 |
| 1295092500 | Jak Properties Inc | In Home Supportive Care | 522 Benham St, Suite B, Bonne Terre, MO 63628 | 2012-04-12 |
| 1013121599 | Joseph Richard Engel | Dentist | 20 W Johnson St, Bonne Terre, MO 63628 | 2007-05-10 |
| 1215093844 | Debra Long Morgan | Dentist | 20 West Johnson Street, Bonne Terre, MO 63628 | 2006-12-28 |
| 1497811459 | Robert Oliver Greenwald | Dentist | #20 W Johnson, Bonne Terre, MO 63628 | 2006-12-27 |
| 1255964508 | American Nursing & Rehab LLC | Assisted Living Facility | 10 Lake Drive, Bonne Terre, MO 63628 | 2020-02-14 |
| 1962679746 | Robert O Greenwald Dds PC | Dentist | #20 W Johnson, Bonne Terre, MO 63628 | 2008-05-12 |
| 1124014030 | Kenny Ratana | Radiology | 527 Benham St # B, Bonne Terre, MO 63628-1205 | 2005-09-26 |
| 1578064796 | Nancy Neece | Counselor | 12 N Allen St, Bonne Terre, MO 63628-1210 | 2018-02-22 |
| 1790958288 | John Paul Lawson Jr. | Pharmacist | 36 N Allen St, Bonne Terre, MO 63628-1210 | 2008-04-07 |
| Find all providers in zip 63628 | ||||
| Taxonomy Code | 261QR1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rural Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841398773 | Farmington Clinic Company LLC | Clinic/Center | 55 Nesbit Dr, Bonne Terre, MO 63628-1353 | 2006-09-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871102137 | Washington County Memorial Hospital | Clinic/Center | 14206 Hwy C, Belgrade, MO 63622 | 2020-07-23 |
| 1891325072 | Scotland County Memorial Hospital | Clinic/Center | 55682 State Highway 6 Ste A, Edina, MO 63537-4268 | 2020-01-16 |
| 1639736457 | Southeast Health Center of Stoddard County LLC | Clinic/Center | 800 Us Highway 61, New Madrid, MO 63869-1106 | 2019-05-28 |
| 1134633456 | Pike County Memorial Hospital | Clinic/Center | 1420 S Business 61 Unit Fde, Bowling Green, MO 63334-5230 | 2017-11-22 |
| 1720505894 | Perry County Health System | Clinic/Center | 210 Hospital Ln Ste 202, Perryville, MO 63775-4200 | 2017-08-29 |
| 1427572007 | Missouri Delta Medical Center | Clinic/Center | 209 W Yoakum Ave, Chaffee, MO 63740-1138 | 2017-07-26 |
| 1790213676 | Jackson Primary Care LLC | Clinic/Center | 2685 E Main St Ste A, Jackson, MO 63755-2474 | 2017-05-23 |
| 1972050581 | Sgoh Acquisition, Inc. | Clinic/Center | 912b State Highway 59, Goodman, MO 64843-8252 | 2016-09-01 |
| 1144605312 | Nevada City Hospital | Clinic/Center | 627 S Ash St Ste B, Nevada, MO 64772 | 2015-07-29 |
| 1669856829 | Ssm Regional Health Services | Clinic/Center | 2511 W Edgewood Dr Ste F, Jefferson City, MO 65109-5869 | 2015-07-16 |
| Find all providers with the same taxonomy | ||||
| City | BONNE TERRE |
| Zip Code | 63628 |
Please comment or provide details below to improve the information on WASHINGTON COUNTY MEMORIAL HOSPITAL.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.