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
2305 GEORGIA ST, LOUISIANA, MO 63353-2559
(573) 754-4584
(573) 754-5280
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
MEDICAID FEE-FOR-SERVICE
MO
05
—
598041002
—
MO
01
—
CK7206
RAILROAD MEDICARE PN
MO
Enumeration date
08/22/2006
Last updated
04/05/2016
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