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
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000011701
MEDICARE PTAN
MO
Enumeration date
04/21/2016
Last updated
10/17/2016
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