Provider Demographics
NPI:1235102690
Name:BOTHWELL REGIONAL HEALTH CENTER
Entity type:Organization
Organization Name:BOTHWELL REGIONAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:660-827-9482
Mailing Address - Street 1:601 E 14TH ST
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65301-5972
Mailing Address - Country:US
Mailing Address - Phone:660-826-8833
Mailing Address - Fax:660-827-3742
Practice Address - Street 1:601 E 14TH ST
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-5972
Practice Address - Country:US
Practice Address - Phone:660-826-8833
Practice Address - Fax:660-827-3742
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOTHWELL REGIONAL HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-08
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO22-48282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO90015010OtherBLUE CROSS HOSPITAL
MO00185026OtherBC PROFEE
MO10157808Medicaid
MO00185016OtherBC PROFEE
MO113710OtherHEALTHLINK ACUTE
MO6192Medicaid
MO540157807Medicaid
MO6191Medicaid
MO7754Medicaid
MO7756Medicaid
MO90015030OtherBC SURGERY
MO304950Medicaid
MO260009Medicare Oscar/Certification
MO6191Medicaid
MOC83431Medicare PIN