# PIKE COUNTY MEMORIAL HOSPITAL

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

## Provider details

- **NPI number:** 1962933143
- **Authorized official:** JUSTIN SELLE (CEO)
- **Authorized official phone:** (573) 754-5531

## Contact information

- **Practice address:** 1420 S BUSINESS 61, UNIT FDE, BOWLING GREEN, MO 63334-5230
- **Practice address phone:** (573) 754-5531
- **Mailing address:** 2305 GEORGIA ST, LOUISIANA, MO 63353-2559
- **Mailing address phone:** (573) 754-5531

## Taxonomy

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

## Other

- **Enumeration date:** 03/21/2017
- **Last updated:** 04/04/2017