NPIMap

Organization Active NPI

John Fitzgibbon Memorial Hospital Inc.

Doing business as Fitzgibbon Professional Building

  • Rural Health Clinic/Center
  • Marshall, MO
National Provider Identifier
1215059985
Registry record updated Mar 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
JOHN FITZGIBBON MEMORIAL HOSPITAL INC.
Doing business as
Fitzgibbon Professional Building
Practice address
2305 S Highway 65
Marshall, MO 65340-3702
Phone
(660) 886-7800
Fax
(660) 831-3328
NPI assigned
Apr 4, 2007
Last updated
Mar 5, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2024

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

Authorized official

Name
Nancy Harris
Title
Cfo/Coo
Phone
(660) 886-7231

Specialties & licenses 1

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

Addresses

Primary practice location

2305 S Highway 65
Marshall, MO 65340-3702

Mailing address

2305 South 65 Highway
Marshall, MO 65340-3702
Phone (660) 886-7800

Other identifiers 1

IdentifierTypeStateIssuer
598987600MedicaidMO

Other names 1

  • Fitzgibbon Professional Building Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040901000838 MO Part A Provider - Rural Health Clinic 2567351570 Practice locations: Marshall, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1215059985. Details of each certification follow.

Rural health clinic certification: CCN 268577

Legal name
JOHN FITZGIBBON MEMORIAL HOSPITAL INC
Doing business as
FITZGIBBON PROFESSIONAL BUILDING
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 20, 2004
Last certification
Nov 22, 2021
Ownership / control type
2A
Organization structure
CorporationNon-profit
Incorporated
Apr 12, 1961 in MO
Enrollment address
2305 S Highway 65
BLDG a
Marshall, MO 65340-3702
Related CCNs
260142

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

Other NPIs with the same Medicare PAC ID 11

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

National Provider Directory

National Provider Directory
Tax ID family
Eastwood Family Clinic9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
John Fitzgibbon Memorial Hospital Inc Organization, Marshall, MO Non-profit 5% Or Greater Direct Ownership Interest Jun 1, 1996 100%
Operational/Managerial Control Jun 1, 1996 100%
Christopher J Sporleder Individual Corporate DirectorPresident of Medical Staff May 1, 2018
W-2 Managing EmployeePresident of Medical Staff May 1, 2018
Jan Stapleton Individual Corporate OfficerBoard Vice President Sep 22, 2015
Jack R Uhrig Individual Corporate DirectorBoard Member Nov 1, 2008
Scott Hartwig Individual Corporate OfficerBoard Secretary/ Treasurer Sep 22, 2015
Jill Lilleman Individual Corporate DirectorBoard Member Oct 25, 2016
William L Summers Individual Corporate OfficerBoard President Jan 1, 1999
Mary Lou Porter Individual Corporate DirectorBoard Member Oct 25, 2016
Nancy K Harris Individual Corporate OfficerCfo Feb 14, 2020
W-2 Managing EmployeeCfo Feb 14, 2020
Robert Blalock Individual Corporate Officer May 29, 2018
W-2 Managing Employee May 29, 2018
Angela P Littrell Individual Corporate OfficerPresident & Ceo Feb 14, 2020
W-2 Managing EmployeePresident & Ceo Jun 2, 2014

Owners & managing parties with NPI records 13

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

View all 13

All facility ownership & control disclosures 7

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Fitzgibbon HospitalMarshall, MO, CCN 260142 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Jul 1, 1966
Jul 1, 1966
Fitzgibbon HospitalMarshall, MO, CCN 26S142 Hospital Operational/Managerial Control (100%) Jul 1, 1966
The Living CenterMarshall, MO, CCN 265688 Skilled nursing facility Operational/Managerial Control (10%) Jul 5, 1995
Akeman McBurney Health ClinicSlater, MO, CCN 268671 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 May 16, 2012
Nov 1, 2010
Fitzgibbon Family HealthFayette, MO, CCN 268731 Rural health clinic Operational/Managerial Control Aug 1, 2014
Mid-Missouri Family Health at FitzgibbonMarshall, MO, CCN 268789 Rural health clinic Operational/Managerial Control Apr 1, 2020
Pilot Grove Medical Clinic at FitzgibbonPilot Grove, MO, CCN 268790 Rural health clinic Operational/Managerial Control Jan 1, 2022

Owned or controlled facilities with NPI records 14

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

View all 14

Facilities with the same owner 7

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

NPI Registry JSON

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

{
    "created_epoch": "1175644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709596800000",
    "number": "1215059985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2305 SOUTH 65 HIGHWAY",
            "city": "MARSHALL",
            "state": "MO",
            "postal_code": "653403702",
            "telephone_number": "660-886-7800",
            "fax_number": "660-831-3328"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2305 S HIGHWAY 65",
            "city": "MARSHALL",
            "state": "MO",
            "postal_code": "653403702",
            "telephone_number": "660-886-7800",
            "fax_number": "660-831-3328"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN FITZGIBBON MEMORIAL HOSPITAL INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-04",
        "last_updated": "2024-03-05",
        "certification_date": "2024-03-05",
        "status": "A",
        "authorized_official_last_name": "HARRIS",
        "authorized_official_first_name": "NANCY",
        "authorized_official_title_or_position": "CFO/COO",
        "authorized_official_telephone_number": "660-886-7231"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "598987600",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fitzgibbon Professional Building",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Fitzgibbon Professional Building",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Marshall, MO

Sources for this page

Verify at the official NPI Registry.