# MISSOURI BAPTIST HOSPITAL OF SULLIVAN

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

## Provider details

- **NPI number:** 1962591958
- **Authorized official:** MR. AUGUSTO A NORONHA II (VICE PRESIDENT FINANCE AND CFO)
- **Authorized official phone:** (314) 996-5118

## Contact information

- **Practice address:** 101 PROGRESS PKWY, SULLIVAN, MO 63080-2359
- **Practice address phone:** (573) 486-3555
- **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:** 10/11/2006
- **Last updated:** 12/02/2011