# MISSOURI BAPTIST HOSPITAL OF SULLIVAN

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Bourbon Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1326131475
- **Authorized official:** MR. TONY SCHWARM (PRESIDENT)
- **Authorized official phone:** (573) 468-4186

## Contact information

- **Practice address:** 240 COLLEGE ST, BOURBON, MO 65441-8308
- **Practice address phone:** (573) 732-5140
- **Practice address fax:** (314) 996-3610
- **Mailing address:** 670 MASON RIDGE CENTER DR, SUITE 300, SAINT LOUIS, MO 63141-8573
- **Mailing address phone:** (314) 996-7644
- **Mailing address fax:** (314) 996-7658

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR1300X | Rural Health Clinic/Center | 355-24 | MO | Yes |

## Other

- **Enumeration date:** 10/02/2006
- **Last updated:** 03/23/2021