Citizens Memorial Health Care Foundation

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

13241672 Issued in MO

Legal business name

CITIZENS MEMORIAL HEALTH CARE FOUNDATION

Practice address

121 W Main
Warsaw, MO 65355-3195

Phone

(660) 438-8966

Fax

(417) 326-3591

NPI assigned

Mar 14, 2012

Organization subpart

No

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

Authorized official

Name

Mr. Gary D Fulbright

Title

Executive Director

Phone

(417) 328-6501

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1331683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581638400000",
    "number": "1659646255",
    "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": "417-326-3591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 W MAIN",
            "city": "WARSAW",
            "state": "MO",
            "postal_code": "653553195",
            "telephone_number": "660-438-8966",
            "fax_number": "417-326-3591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITIZENS MEMORIAL HEALTH CARE FOUNDATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-14",
        "last_updated": "2020-02-14",
        "certification_date": "2020-02-14",
        "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",
        "authorized_official_name_prefix": "Mr."
    },
    "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": []
}

• Seth D Casey, LCSW
• Chelsea Dechelle Casteel, FNP-BC
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• Robert J Chapman, RPT
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• Tiffany Mary Crowell, PHARMD
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• Ashley J Degraffenreid, LPN
• Kylee Dillon, PT, DPT
• Stacey A Dobbs, FNP

• All providers in Warsaw, MO
• Durable Medical Equipment & Medical Supplies in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.