NPIMap

Organization Active NPI

Citizens Memorial Hospital District

  • Pharmacy
  • Bolivar, MO
National Provider Identifier
1801318472
Registry record updated Dec 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
Legal business name
CITIZENS MEMORIAL HOSPITAL DISTRICT
Practice address
1100 S Springfield Ave
Bolivar, MO 65613-2512
Phone
(417) 326-6003
Fax
(417) 777-5806
NPI assigned
Jul 14, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2024

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X Primary

Addresses

Primary practice location

1100 S Springfield Ave
Bolivar, MO 65613-2512

Mailing address

1100 S Springfield Ave
Bolivar, MO 65613-2512
Phone (417) 326-6003

Other identifiers 1

IdentifierTypeStateIssuer
2169973OtherPK

Other names 1

  • Stephens Pharmacy at CMH Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20200430001636 MO Part B Supplier - Pharmacy 1658413455 Practice locations: Bolivar, MO
O20250416000954 MO DME Supplier - Pharmacy 2769574433 Practice locations: Bolivar, MO

Other NPIs with the same Medicare PAC ID 16

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

View all 16

National Provider Directory

National Provider Directory
Tax ID family
James L Molchan MD12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

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

Locations

1218 W Locust St
Bolivar, MO 65613
Phone (417) 326-7648

1125A N Butterfield Rd
Bolivar, MO 65613

105 N Grand St
#3
Greenfield, MO 65661
Phone (417) 637-0700

121 W Main St
Warsaw, MO 65355
Phone (660) 438-8966

Ownership & related parties

All facility ownership & control disclosures 19

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Citizens Memorial HospitalBolivar, MO, CCN 260195 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Aug 1, 1981
Aug 1, 1981
Citizens Memorial HospitalBolivar, MO, CCN 26S195 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Aug 1, 1981
Aug 1, 1981
Citizens Memorial HospitalBolivar, MO, CCN 26U195 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Aug 1, 1981
Aug 1, 1981
Ellett Memorial HospitalAppleton City, MO, CCN 261301 Hospital Operational/Managerial Control Nov 1, 2013
Ellett Memorial HospitalAppleton City, MO, CCN 26Z301 Hospital Operational/Managerial Control (75%) Jun 1, 2018
Ac Rural Health ClinicAppleton City, MO, CCN 268593 Rural health clinic Operational/Managerial Control (75%) Jun 1, 2018
Humansville Family Medical CenterHumansville, MO, CCN 263976 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jul 3, 1990
Jul 3, 1990
Pleasant Hope Family Medical CenterPleasant Hope, MO, CCN 268552 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Oct 14, 2000
Oct 14, 2000
Butterfield Park Medical CenterBolivar, MO, CCN 268553 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Oct 1, 1991
Oct 1, 1991
Dade County Family Medical CenterGreenfield, MO, CCN 263411 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Dec 1, 1992
Dec 1, 1992
Stockton Family Medical CenterStockton, MO, CCN 263977 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Aug 1, 1994
Jan 1, 2007
Ash Grove Family Medical CenterAsh Grove, MO, CCN 263471 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Mar 1, 1994
Mar 1, 1994
CMH OB/GYN and Pediatric ClinicBolivar, MO, CCN 268554 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Mar 2, 2001
Mar 2, 2001
Dallas County Family Medical CenterBuffalo, MO, CCN 263482 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Nov 1, 1995
Nov 1, 1995
Southside Medical CenterBolivar, MO, CCN 268668 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Aug 1, 2011
Aug 1, 2011
Bolivar Family Care CenterBolivar, MO, CCN 268694 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Oct 1, 2013
Oct 1, 2013
CMH Osceola Medical CenterOsceola, MO, CCN 268727 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Nov 1, 2014
Nov 1, 2014
CMH El Dorado Springs Medical CenterEl Dorado Springs, MO, CCN 268751 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jan 3, 2017
Jan 3, 2017
CMH Willard Medical CenterWillard, MO, CCN 268791 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Dec 6, 2021
Dec 6, 2021

Owned or controlled facilities with NPI records 19

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

View all 19

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1499990400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733097600000",
    "number": "1801318472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 S SPRINGFIELD AVE",
            "city": "BOLIVAR",
            "state": "MO",
            "postal_code": "656132512",
            "telephone_number": "417-326-6003",
            "fax_number": "417-777-5806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 S SPRINGFIELD AVE",
            "city": "BOLIVAR",
            "state": "MO",
            "postal_code": "656132512",
            "telephone_number": "417-326-6003",
            "fax_number": "417-777-5806"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITIZENS MEMORIAL HOSPITAL DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-14",
        "last_updated": "2024-12-02",
        "certification_date": "2024-12-02",
        "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": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2169973",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Stephens Pharmacy at CMH",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bolivar, MO

Sources for this page

Verify at the official NPI Registry.