John Fitzgibbon Memorial Hospital Inc
Organization Active NPI Wound Care Registered Nurse · Marshall, MO
NPI 1073748786 · NPPES record last updated Mar 5, 2024
Key facts
- NPI
- 1073748786
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Wound Care Registered Nurse 163WW0000X
- License
- 27-57 (MO)
- Legal business name
- JOHN FITZGIBBON MEMORIAL HOSPITAL INC
- Practice address
- 2305 South 65 Highway
Marshall, MO 65340-3702 - Phone
- (660) 886-7431
- Fax
- (660) 886-9001
- NPI assigned
- May 26, 2009
- Organization subpart
- Yes
- Parent organization (as reported)
- JOHN FITZGIBBON MEMORIAL HOSPITAL, INC.
Authorized official
- Name
- Nancy Harris
- Title
- Cfo/Coo
- Phone
- (660) 886-7231
Other NPIs on the same Medicare enrollment 14
Corporate family (same tax ID) 8
Member organizations 2
Practitioners 3
-
Roy J Elfrink, M.D.
-
David J Keuhn, M.D.
-
Jason E Gault, DO
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040315000980 | MO | Part B Supplier - Clinic/Group Practice | 2567351570 |
Receives reassigned benefits from 68 practitioners 14 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Marshall, MO; Pilot Grove, MO |
National Provider Directory
- Tax ID family
- Marshall Surgical Assoc
- Part of
- Marshall Surgical Assoc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Wound Care Registered Nurse |
163WW0000X | 109128 | MO | |
| Wound Care Registered Nurse |
163WW0000X | 27-57 | MO | Yes |
Addresses
Primary practice location
2305 South 65 Highway
Marshall, MO 65340-3702
Mailing address
2305 South 65 Highway
Marshall, MO 65340-3702
Phone (660) 886-7431
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073748786 | Medicaid | MO |
Other names
- Fitzgibbon Wound Care
Other providers in Marshall, MO
- Isd Renal Inc
- Nicholas Jackson
- Jefferson City Medical Group-P C
- Jefferson City Medical Group, PC
- John Fitzgibbon Memorial Hospital
- John Fitzgibbon Memorial Hospital Inc
- John Fitzgibbon Memorial Hospital Inc
- John Fitzgibbon Memorial Hospital Inc
- John Fitzgibbon Memorial Hospital Inc
- John Fitzgibbon Memorial Hospital Inc
All providers in Marshall, MO · Wound Care Registered Nurse in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 5, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.