NPIMap

Organization Active NPI

Citizens Memorial Healthcare

  • Rural Health Clinic/Center
  • Buffalo, MO
National Provider Identifier
1609080571
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
Practice address
201 S Ash St
Buffalo, MO 65622-8674
Phone
(417) 345-6100
Fax
(417) 345-6866
NPI assigned
May 10, 2007
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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

201 S Ash St
Buffalo, MO 65622-8674

Mailing address

1500 N Oakland Ave
Bolivar, MO 65613-3011

Other names 1

  • Dallas County Family Medical Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080125000602 MO Part A Provider - Rural Health Clinic 4183528169 Practice locations: Buffalo, MO

Rural health clinic certification: CCN 263482

Legal name
CITIZENS MEMORIAL HEALTHCARE
Doing business as
DALLAS COUNTY FAMILY MEDICAL CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 6, 1996
Last certification
Dec 2, 2024
Ownership / control type
2B
Organization structure
OtherNon-profit
Enrollment address
201 S Ash St
Buffalo, MO 65622-8674
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

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.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
26D0906644Dallas County Family Medical Center201 South Ash Street, Buffalo, MO 65622ComplianceMar 4, 2028

National Provider Directory

National Provider Directory
Tax ID family
Citizens Memorial Healthcare19 organizations share this tax ID, including this one
Part of
James L Molchan MD

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.

Locations

1500 N Oakland Ave
#J
Bolivar, MO 65613

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Corey Rich Individual Corporate DirectorBoard Member Nov 21, 2017
Robin R Sechler Individual Corporate OfficerSecretary Dec 20, 2011
Michael Calhoun Individual Corporate OfficerCeo Jan 1, 2022
W-2 Managing EmployeeCeo Jan 1, 2022
Citizens Memorial Hospital District Organization, Bolivar, MO Created for acquisition, Medical provider/supplier 5% Or Greater Direct Ownership Interest Nov 1, 1995 100%
Operational/Managerial Control Nov 1, 1995 100%
Gary D Fulbright Individual Corporate OfficerCeo Feb 1, 2020
W-2 Managing EmployeeCeo Jan 1, 2020
Harold D Berry Individual Corporate OfficerBoard Member Mar 20, 2012
Corporate DirectorBoard Member Mar 20, 2012
John Kallenbach Individual Corporate DirectorBoard Member Jul 17, 2018
Janieca Lynn Hancock Individual Corporate OfficerBoard Member Apr 18, 2023
Renee M Meyer Individual W-2 Managing EmployeeCfo Jan 1, 2020
Kerry P Douglas Individual Corporate OfficerBoard 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 144

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 144

NPI Registry JSON

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

{
    "created_epoch": "1178755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1761004800000",
    "number": "1609080571",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 S ASH ST",
            "city": "BUFFALO",
            "state": "MO",
            "postal_code": "656228674",
            "telephone_number": "417-345-6100",
            "fax_number": "417-345-6866"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITIZENS MEMORIAL HEALTHCARE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CITIZENS MEMORIAL HOSPITAL DISTRICT",
        "enumeration_date": "2007-05-10",
        "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": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dallas County Family Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Buffalo, MO

Sources for this page

Verify at the official NPI Registry.