Organization
PIKE COUNTY MEMORIAL HOSPITAL
Active
Other names
PCMH Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
JUSTIN SELLE (CEO)
(573) 754-5531
Entity
Organization
Contact information
Practice address
1015 W ADAMS ST, BOWLING GREEN, MO 63334-1974
(573) 324-5300
(573) 324-6059
Mailing address
2305 GEORGIA ST, LOUISIANA, MO 63353-2559
(573) 754-4584
(573) 754-5280
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
502663305
MEDICARE/MEDICAID PROF CROSSOVER 1500
MO
05
—
598209203
—
MO
01
—
CK7206
RAILROAD MEDICARE PIN
MO
Enumeration date
08/13/2006
Last updated
04/05/2016
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