1003181777 NPI number — CITIZENS MEMORIAL HEALTH CARE FOUNDATION

Table of content: ALLISON RENE KING CNM, MSN, ARNP (NPI 1588913602)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003181777 NPI number — CITIZENS MEMORIAL HEALTH CARE FOUNDATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITIZENS MEMORIAL HEALTH CARE FOUNDATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003181777
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/24/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1500 N OAKLAND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOLIVAR
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65613-3011
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-326-6000
Provider Business Mailing Address Fax Number:
417-328-6242

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
105 N GRAND ST STE 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENFIELD
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65661-8198
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-637-0700
Provider Business Practice Location Address Fax Number:
417-326-3591
Provider Enumeration Date:
03/14/2012

Additional Information

Authorized Official

Authorized Official Last Name:
MEYER
Authorized Official First Name:
RENEE
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
DIRECTOR OF FINANCE
Authorized Official Telephone Number:
417-328-6258

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  13241672 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 621752500 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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