1003181777 NPI number — CITIZENS MEMORIAL HEALTH CARE FOUNDATION

Table of content: (NPI 1003181777)

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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