Provider Demographics
NPI:1538247887
Name:SKAGGS COMMUNITY HOSPITAL ASSOCIATION
Entity type:Organization
Organization Name:SKAGGS COMMUNITY HOSPITAL ASSOCIATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:ERIXON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-335-7270
Mailing Address - Street 1:590 BIRCH STREET
Mailing Address - Street 2:STE 2C
Mailing Address - City:HOLLISTER
Mailing Address - State:MO
Mailing Address - Zip Code:65672
Mailing Address - Country:US
Mailing Address - Phone:417-335-7337
Mailing Address - Fax:417-335-7588
Practice Address - Street 1:590 BIRCH STREET
Practice Address - Street 2:STE 2C
Practice Address - City:HOLLISTER
Practice Address - State:MO
Practice Address - Zip Code:65672
Practice Address - Country:US
Practice Address - Phone:417-335-7337
Practice Address - Fax:417-335-7588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2008-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO5248208000000X
261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
268600Medicare Oscar/Certification
260094Medicare Oscar/Certification