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
1015 W ADAMS ST, BOWLING GREEN, MO 63334-1974
(573) 324-5300
(573) 324-6059
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000012300
MEDICARE PTAN
MO
Enumeration date
04/21/2016
Last updated
04/26/2016
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