# PIKE COUNTY MEMORIAL HOSPITAL

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

## Provider details

- **NPI number:** 1538513072
- **Authorized official:** JUSTIN SELLE (CEO)
- **Authorized official phone:** (573) 754-5531

## Contact information

- **Practice address:** 2305 GEORGIA ST, LOUISIANA, MO 63353-2559
- **Practice address phone:** (573) 754-4584
- **Practice address fax:** (573) 754-5280
- **Mailing address:** 2305 GEORGIA ST, LOUISIANA, MO 63353-2559
- **Mailing address phone:** (573) 754-4584
- **Mailing address fax:** (573) 754-5280

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 04/21/2016
- **Last updated:** 10/17/2016