Provider Demographics
NPI:1174585103
Name:HANNIBAL REGIONAL HOSPITAL
Entity type:Organization
Organization Name:HANNIBAL REGIONAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. VICE PRESIDENT OF PATIENT CARE
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:JACO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-248-5257
Mailing Address - Street 1:4537 W ELY RD
Mailing Address - Street 2:#804
Mailing Address - City:HANNIBAL
Mailing Address - State:MO
Mailing Address - Zip Code:63401-2546
Mailing Address - Country:US
Mailing Address - Phone:573-248-3889
Mailing Address - Fax:
Practice Address - Street 1:188A MEDICAL DR
Practice Address - Street 2:
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401-6877
Practice Address - Country:US
Practice Address - Phone:573-406-0576
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20020302112255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty