Provider Demographics
NPI:1902851843
Name:BATES COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:BATES COUNTY MEMORIAL HOSPITAL
Other - Org Name:FAMILY CARE CLINIC HIGH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-200-7000
Mailing Address - Street 1:706 S HIGH ST
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:MO
Mailing Address - Zip Code:64730-1833
Mailing Address - Country:US
Mailing Address - Phone:660-200-7135
Mailing Address - Fax:660-200-7015
Practice Address - Street 1:706 S HIGH ST
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:MO
Practice Address - Zip Code:64730-1833
Practice Address - Country:US
Practice Address - Phone:660-200-7135
Practice Address - Fax:660-200-7015
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BATES COUNTY MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-22
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO205 45207Q00000X
MO205 49261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO24435010OtherBLUE CROSS
MO590472908Medicaid
MO24435010OtherBLUE CROSS
MO6030000Medicare ID - Type Unspecified
MO1902851843Medicaid