SULLIVAN COUNTY MEMORIAL HOSPITAL
NPI 1063553642
Emergency Medicine in Milan, MO
NPI Status: Active since February 08, 2007
Contact Information
630 W 3RD ST
MILAN, MO
ZIP 63556
Phone: (660) 265-4212
Fax: (660) 265-4898
- Organization
- Emergency Medicine
- Accepts Insurance
- CLIA Number: 26D0441684
- CLIA Cert. Type: Rural Health Clinic
- CLIA Exp. Date: 08-31-2026
About SULLIVAN COUNTY MEMORIAL HOSPITAL
This page provides the complete NPI Profile along with additional information for Sullivan County Memorial Hospital, a provider established in Milan, Missouri operating as a Emergency Medicine. The healthcare provider is registered in the NPI registry with number 1063553642 assigned on February 2007. The practitioner's primary taxonomy code is 207P00000X with license number 130-49 (MO). The provider is registered as an organization and their NPI record was last updated 15 years ago. The organization operates as a Single Specialty Group with one or more individual practitioners, all of who practice with the same area of specialization. The authorized official of this NPI record is Amy Michael (Chief Financial Officer)
- NPI
- 1063553642
- Provider Name
- SULLIVAN COUNTY MEMORIAL HOSPITAL
- Entity Type
- Organization
- Location Address
- 630 W 3RD ST MILAN, MO 63556
- Location Phone
- (660) 265-4212
- Location Fax
- (660) 265-4898
- Mailing Address
- 630 W 3RD ST MILAN, MO 63556
- Mailing Phone
- (660) 265-4212
- Mailing Fax
- (660) 265-4898
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 02-08-2007
- Last Update Date
- 05-16-2011
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Emergency Medicine
- Taxonomy Code
- 207P00000X
- Type
- Allopathic & Osteopathic Physicians
- License No.
- 130-49
- License State
- MO
- Taxonomy Description
- An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury.
Group Taxonomy 193400000X SINGLE SPECIALTY GROUP
This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Anthem Bronze Pathway 10150 ($0 Virtual PCP + $0 Select Drugs + Incentives) - EPO
- Anthem Bronze Pathway 6900 ($0 Virtual PCP + $0 Select Drugs + Incentives) - EPO
- Anthem Bronze Pathway 7500 Standard ($0 Virtual PCP + $0 Select Drugs + Incentives) - EPO
- Anthem Catastrophic Pathway (+ Incentives) - EPO
- Anthem Gold Pathway 2000 Standard ($0 Virtual PCP + $0 Select Drugs + Incentives) - EPO
- Anthem Heart Healthy Bronze Pathway 4900 ($0 Virtual PCP + $0 Select Drugs + Incentives) - EPO
- Anthem Heart Healthy Silver Pathway 3100 ($0 Virtual PCP + $0 Select Drugs + Incentives) - EPO
- Anthem Silver Pathway 5350 ($0 Virtual PCP + $0 Select Drugs + Incentives) - EPO
- Anthem Silver Pathway 6000 Standard ($0 Virtual PCP + $0 Select Drugs + Incentives) - EPO
- Anthem Silver Pathway 7200 ($0 Virtual PCP + $0 Select Drugs + Incentives) - EPO
- UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) - EPO
- UHC Bronze Essential (No Referrals) - EPO
- UHC Bronze Standard (No Referrals) - EPO
- UHC Bronze Standard+ (Dental + Vision, No Referrals) - EPO
- UHC Gold Advantage ($0 Virtual Urgent Care, No Referrals) - EPO
- UHC Gold Advantage+ ($0 Virtual Urgent Care, Dental + Vision, No Referrals) - EPO
- UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, $8 Tier 2 Rx, No Referrals) - EPO
- UHC Gold Standard (No Referrals) - EPO
- UHC Silver Advantage ($0 Virtual Urgent Care, No Referrals) - EPO
- UHC Silver Advantage+ ($0 Virtual Urgent Care, Dental + Vision, No Referrals) - EPO
- UHC Silver Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) - EPO
- UHC Silver Standard (No Referrals) - EPO
- UHC Silver Standard+ (Dental + Vision, No Referrals) - EPO
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 000050097 | MEDICARE ID-TYPE UNSPECIFIED (04) | ||
| 540324803 | MEDICAID (05) | MO |
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 26D0441684
- Facility Type
- Rural Health Clinic
- Certificate Effective Date
- September 01, 2024
- Certificate Expiration Date
- August 31, 2026
- Laboratory Director
- DALE W. ESSMYER
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Sullivan County Memorial Hospital to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1063553642, we treat the final digit (2) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 58. The final step is to find the difference between that total and the next multiple of ten (60 - 58 = 2).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 58 is 60. The difference is the calculated check digit.
Other Providers at the Same Location
The following 10 providers are registered at the same or a nearby location.
MILAN, MO 63556
MILAN, MO 63556
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1063553642, enumerated as an "organization" on February 08, 2007.
The provider is located at 630 W 3RD ST MILAN, MO 63556 and the phone number is (660) 265-4212.
Emergency Medicine with taxonomy code 207P00000X.
The provider might be accepting Accepts: Anthem Blue Cross and Blue Shield,. Please consult your insurance carrier or call the provider to verify.
