NPIMap

Organization Active NPI

Citizens Memorial Health Care Foundation

  • Durable Medical Equipment & Medical Supplies
  • Bolivar, MO
National Provider Identifier
1285605477
Registry record updated Feb 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
License
13241672 Issued in MO
Legal business name
CITIZENS MEMORIAL HEALTH CARE FOUNDATION
Practice address
1915 S Springfield Ave
Bolivar, MO 65613-9684
Phone
(417) 326-3584
Fax
(417) 326-3591
NPI assigned
Jan 27, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2020

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

Authorized official

Name
Gary D Fulbright
Title
Executive Director
Phone
(417) 328-6501

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 13241672 MO Primary

Addresses

Primary practice location

1915 S Springfield Ave
Bolivar, MO 65613-9684

Mailing address

1500 N Oakland Ave
Bolivar, MO 65613-3011
Phone (417) 326-6000

Other identifiers 1

IdentifierTypeStateIssuer
621752500MedicaidMO

Other names 1

  • Citizens Memorial Home Medical Equipment Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930076538 MO DME Supplier - Medical Supply Company With Respiratory TherapistDME Supplier - Medical Supply CompanyDME Supplier - Orthotic PersonnelDME Supplier - Prosthetic PersonnelDME Supplier - Oxygen & Equipment 1658413455 Practice locations: Bolivar, MO

Other NPIs with the same Medicare PAC ID 10

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
CMH Home Medical Equipment1915 S Springfield Ave, Bolivar, MO 65613-9684(417) 328-7240 Commodes, Urinals, Bedpans|Continuous Passive Motion (CPM) Devices|Blood Glucose Monitors/Supplies (Non-Mail Order)|Blood Glucose Monitors/Supplies (Mail Order)|Heat & Cold Applications|Hospital Beds (Electric)|Hospital Beds (Manual)|Negative Pressure Wound Therapy Pumps/Supplies|Pneumatic Compress… Does not accept assignmentParticipating since Jan 1, 2015

National Provider Directory

National Provider Directory
Tax ID family
Citizens Memorial Healthcare Foundation Homemaker Plus14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

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

View all 13

Locations

309 S Ash St
#101
Buffalo, MO 65622

121 W Main St
Warsaw, MO 65355

NPI Registry JSON

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

{
    "created_epoch": "1138320000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581465600000",
    "number": "1285605477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 N OAKLAND AVE",
            "city": "BOLIVAR",
            "state": "MO",
            "postal_code": "656133011",
            "telephone_number": "417-326-6000",
            "fax_number": "417-328-6242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1915 S SPRINGFIELD AVE",
            "city": "BOLIVAR",
            "state": "MO",
            "postal_code": "656139684",
            "telephone_number": "417-326-3584",
            "fax_number": "417-326-3591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITIZENS MEMORIAL HEALTH CARE FOUNDATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-27",
        "last_updated": "2020-02-12",
        "certification_date": "2020-02-12",
        "status": "A",
        "authorized_official_last_name": "FULBRIGHT",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "417-328-6501"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "MO",
            "license": "13241672",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "621752500",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Citizens Memorial Home Medical Equipment",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Citizens Memorial Home Medical Equipment",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bolivar, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.