John Fitzgibbon Memorial Hospital Inc.
Organization Active NPI Diagnostic Radiology Physician · Marshall, MO
NPI 1750155818 · NPPES record last updated Mar 5, 2024
Key facts
- NPI
- 1750155818
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Diagnostic Radiology Physician 2085R0202X
- Legal business name
- JOHN FITZGIBBON MEMORIAL HOSPITAL INC.
- Practice address
- 2305 S Highway 65
Marshall, MO 65340-3702 - Phone
- (660) 886-7431
- NPI assigned
- Nov 9, 2023
- Organization subpart
- No
Authorized official
- Name
- Nancy Harris
- Title
- Cfo/Coo
- Phone
- (660) 886-7431
Owned or controlled facilities with NPI records 15
Other NPIs with the same Medicare PAC ID 11
Corporate family (same tax ID) 8
Practitioners 87
-
David P. Brummett, M.D.
-
Eric D Bettis, DO
-
Kaylea Bultmann, FNP
-
Pearl Carrillo, DO
-
Yan Chen, MD, PHD
-
Patricia Lynn Klinger Day, FNP-BC
-
Karla Dora Dobbs, D.O.
-
Brenda K Dodds, RN, FNP-C, FNP
-
Deanna C Donnell, CNM
-
Mary J Drenon, FNP
-
Amber Renee Drumheller, PMHNP-BC
-
Roy J Elfrink, M.D.
-
Ann Marie Gray, M.D.
-
Darin Lee Haug, DO
-
Deborah Ann Herrmann, M.D.
-
James H Kerns, MD
-
David J Keuhn, M.D.
-
Carrie A Lucas, RN, FNP
-
Carrie M Peecher, DO
-
Wallace Eugene Ralston, CRNA
-
Jared Karl Romney, D.O.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
All facility ownership & control disclosures 8
| Facility | Type | Role | Since |
|---|---|---|---|
| Fitzgibbon Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control |
Jul 1, 1966 Jul 1, 1966 |
| Fitzgibbon Hospital |
Hospital | Operational/Managerial Control (100%) | Jul 1, 1966 |
| The Living Center |
Skilled nursing facility | Operational/Managerial Control (10%) | Jul 5, 1995 |
| Fitzgibbon Professional Building |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Jun 1, 1996 Jun 1, 1996 |
| Akeman McBurney Health Clinic |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
May 16, 2012 Nov 1, 2010 |
| Fitzgibbon Family Health |
Rural health clinic | Operational/Managerial Control | Aug 1, 2014 |
| Mid-Missouri Family Health at Fitzgibbon |
Rural health clinic | Operational/Managerial Control | Apr 1, 2020 |
| Pilot Grove Medical Clinic at Fitzgibbon |
Rural health clinic | Operational/Managerial Control | Jan 1, 2022 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20231120001012 | MO | Part B Supplier - Clinic/Group Practice | 2567351570 |
Receives reassigned benefits from 2 practitioners Practice locations: Marshall, MO |
National Provider Directory
- Tax ID family
- Marshall Surgical Assoc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician |
2085R0202X | Yes |
Addresses
Primary practice location
2305 S Highway 65
Marshall, MO 65340-3702
Mailing address
2305 S Highway 65
Marshall, MO 65340-3702
Phone (660) 886-7431
Other names
- Fitzgibbon Radiology Group
Other providers in Marshall, MO
- John Fitzgibbon Memorial Hospital Inc
- John Fitzgibbon Memorial Hospital Inc
- John Fitzgibbon Memorial Hospital Inc
- John Fitzgibbon Memorial Hospital Inc.
- John Fitzgibbon Memorial Hospital Inc.
- John Fitzgibbon Memorial Hospital, Inc
- John Fitzgibbon Memorial Hospital, Inc.
- John Fitzgibbon Memorial Hospital, Inc.
- John Fitzgibbon Memorial Hospital, Inc.
- John Fitzgibbon Memorial Hospital, Inc.
All providers in Marshall, MO · Diagnostic Radiology Physician in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 5, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.