NPIMap

Organization Active NPI

Citizens Memorial Healthcare

Doing business as Bolivar Family Care Center

  • Rural Health Clinic/Center
  • Bolivar, MO
National Provider Identifier
1063588960
Registry record updated Oct 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
CITIZENS MEMORIAL HEALTHCARE
Doing business as
Bolivar Family Care Center
Practice address
1240 N Butterfield Rd
Bolivar, MO 65613-3016
Phone
(417) 326-6021
Fax
(417) 326-6347
NPI assigned
Nov 24, 2006
Last updated
Oct 21, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
CITIZENS MEMORIAL HOSPITAL DISTRICTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 21, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Renee Marie Meyer
Title
Cfo
Phone
(417) 328-6258

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

1240 N Butterfield Rd
Bolivar, MO 65613-3016

Mailing address

1240 N Butterfield Rd
Bolivar, MO 65613-3016
Phone (417) 326-6021

Other identifiers 1

IdentifierTypeStateIssuer
596054304MedicaidMO

Other names 1

  • Bolivar Family Care Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20131115001582 MO Part A Provider - Rural Health Clinic 4183528169 Practice locations: Bolivar, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1063588960. Details of each certification follow.

Rural health clinic certification: CCN 268694

Legal name
CITIZENS MEMORIAL HEALTHCARE
Doing business as
BOLIVAR FAMILY CARE CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
May 8, 2003
Last certification
Dec 2, 2024
Ownership / control type
2B
Organization structure
OtherNon-profit
Enrollment address
1240 N Butterfield Rd
Bolivar, MO 65613-3016
Related CCNs
260195

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 13

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 13

National Provider Directory

National Provider Directory
Tax ID family
Citizens Memorial Healthcare19 organizations share this tax ID, including this one
Part of
Citizens Memorial District

Other organizations with this tax ID 18

Organizations that report the same tax identification number in the National Provider Directory.

View all 18

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 9

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Joan M Woods Individual Corporate DirectorBoard Member Jul 23, 2019
Corey Rich Individual Corporate DirectorBoard Member Nov 21, 2017
Robin R Sechler Individual Corporate DirectorBoard Member Dec 20, 2011
Michael Calhoun Individual Corporate OfficerCeo Jan 1, 2022
Corporate DirectorCeo Jan 1, 2022
Citizens Memorial Hospital District Organization, Bolivar, MO Medical provider/supplier, Non-profit 5% Or Greater Direct Ownership Interest Oct 1, 2013 100%
Operational/Managerial Control Oct 1, 2013 100%
Harold D Berry Individual Corporate DirectorBoard Member Mar 20, 2012
John Kallenbach Individual Corporate DirectorBoard Member Jul 17, 2018
Renee M Meyer Individual Corporate OfficerCfo Jan 1, 2020
W-2 Managing EmployeeCfo Jan 1, 2020
Kerry P Douglas Individual Corporate DirectorBoard Member Apr 5, 2011

Owners & managing parties with NPI records 7

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 18

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 18

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164326400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1761004800000",
    "number": "1063588960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1240 N BUTTERFIELD RD",
            "city": "BOLIVAR",
            "state": "MO",
            "postal_code": "656133016",
            "telephone_number": "417-326-6021",
            "fax_number": "417-326-6347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1240 N BUTTERFIELD RD",
            "city": "BOLIVAR",
            "state": "MO",
            "postal_code": "656133016",
            "telephone_number": "417-326-6021",
            "fax_number": "417-326-6347"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITIZENS MEMORIAL HEALTHCARE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CITIZENS MEMORIAL HOSPITAL DISTRICT",
        "enumeration_date": "2006-11-24",
        "last_updated": "2025-10-21",
        "certification_date": "2025-10-21",
        "status": "A",
        "authorized_official_last_name": "MEYER",
        "authorized_official_first_name": "RENEE",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "417-328-6258"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "596054304",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bolivar Family Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bolivar, MO

Sources for this page

Verify at the official NPI Registry.