NPIMap

Organization Active NPI

Citizens Memorial Healthcare Clinics

  • Durable Medical Equipment & Medical Supplies
  • Bolivar, MO
National Provider Identifier
1972769404
Registry record updated Aug 4, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
License
313-25 Issued in MO
Legal business name
CITIZENS MEMORIAL HEALTHCARE CLINICS
Practice address
1630 Killingsworth Ave
Bolivar, MO 65613-2282
Phone
(417) 326-6200
Fax
(417) 777-7463
NPI assigned
Aug 4, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2008

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

Authorized official

Name
Brenda K Shepherd
Title
Provider Application Specialist
Phone
(417) 328-7705

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 313-25 MO Primary

Addresses

Primary practice location

1630 Killingsworth Ave
Bolivar, MO 65613-2282

Mailing address

PO Box 939
Bolivar, MO 65613-0939
Phone (417) 777-6911

Other identifiers 1

IdentifierTypeStateIssuer
626365001MedicaidMO

Other names 1

  • CMH Foot & Ankle Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Citizens Memorial Healthcare19 organizations share this tax ID, including this one

Other organizations with this tax ID 18

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

View all 18

Locations

1630 Killingsworth Ave
Bolivar, MO 65613
Phone (417) 326-6200

Practitioners & affiliated clinicians

Practitioners 4

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": "1217808000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217808000000",
    "number": "1972769404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 939",
            "city": "BOLIVAR",
            "state": "MO",
            "postal_code": "656130939",
            "telephone_number": "417-777-6911",
            "fax_number": "417-326-6936"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1630 KILLINGSWORTH AVE",
            "city": "BOLIVAR",
            "state": "MO",
            "postal_code": "656132282",
            "telephone_number": "417-326-6200",
            "fax_number": "417-777-7463"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITIZENS MEMORIAL HEALTHCARE CLINICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-04",
        "last_updated": "2008-08-04",
        "status": "A",
        "authorized_official_last_name": "SHEPHERD",
        "authorized_official_first_name": "BRENDA",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PROVIDER APPLICATION SPECIALIST",
        "authorized_official_telephone_number": "417-328-7705"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "MO",
            "license": "313-25",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "626365001",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CMH Foot & Ankle Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bolivar, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 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.