Organization
PEMISCOT COUNTY MEMORIAL HOSPITAL
Active
Other names
Portageville Primary Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
MARK R DAVIS (CEO)
(573) 359-3612
Entity
Organization
Contact information
Practice address
314 E MAIN ST, PORTAGEVILLE, MO 63873-1616
(573) 379-3777
(573) 379-9331
Mailing address
314 E MAIN ST, PORTAGEVILLE, MO 63873-1616
(573) 379-3777
(573) 379-9331
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
596948109
—
MO
Enumeration date
09/20/2006
Last updated
05/12/2016
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