Dexter Hospital LLC

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

DEXTER HOSPITAL LLC

Doing business as

Jibben Medical

Practice address

1525 W Business Hwy 60
Dexter, MO 63841

Phone

(573) 624-8447

Fax

(573) 624-4312

NPI assigned

Nov 7, 2006

Last updated

Sep 11, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Sue Ann Williams

Title

Clinic Administrator

Phone

(573) 624-1640

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• JIBBEN MEDICAL Doing business as

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Laurie Muriel Jibben, APN

  • Family Nurse Practitioner
  • Dexter, MO
  • NPI 1285629543
  NPD (past)
• Robert J Jibben, DO

  • Family Medicine Physician
  • Dexter, MO
  • NPI 1043209836
  NPD (past)

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

{
    "created_epoch": "1162857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1221091200000",
    "number": "1710056213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 368",
            "city": "DEXTER",
            "state": "MO",
            "postal_code": "638410368",
            "telephone_number": "573-624-3165",
            "fax_number": "573-624-3157"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1525 W BUSINESS HWY 60",
            "city": "DEXTER",
            "state": "MO",
            "postal_code": "63841",
            "telephone_number": "573-624-8447",
            "fax_number": "573-624-4312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEXTER HOSPITAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-07",
        "last_updated": "2008-09-11",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "SUE",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "CLINIC ADMINISTRATOR",
        "authorized_official_telephone_number": "573-624-1640",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "504910001",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "DC5219",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "JIBBEN MEDICAL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Rural Health Clinic/Center in Dexter, MO
• Providers in Dexter, MO by specialty
• Rural Health Clinic/Center in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2008; 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.