Organization
COOPER COUNTY MEMORIAL HOSPITAL
Active
Other names
CCMH Family Health Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DANIELLE GEARHART (ADMIN CEO)
(660) 882-7461
Entity
Organization
Contact information
Practice address
600 W MORRISON ST, SUITE 5, FAYETTE, MO 65248-1075
(660) 248-2900
(660) 248-1544
Mailing address
17651 B HWY, BOONVILLE, MO 65233-2839
(660) 882-7461
(660) 882-4136
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
26-3483
MEDICARE ID/OSCAR
MO
05
—
590328506
—
MO
Enumeration date
03/14/2007
Last updated
07/25/2014
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