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NPI Code Detail

MEDICARE: CITIZENS MEMORIAL HEALTH CARE FOUNDATION

MEDICARE: CITIZENS MEMORIAL HEALTH CARE FOUNDATION
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QD0000XDental Clinic/Center

General Provider Information

NPI Number : 1639384597
Entity Type Code : Organization
Provider Name (Legal Business Name) : CITIZENS MEMORIAL HEALTH CARE FOUNDATION
Provider Business Mailing Address
First Line : 1500 N. OAKLAND AVE
Second Line :
City : BOLIVAR
State : MO
Zip : 65613-3099
Country : US
Telephone Number : 417-326-6334
Fax Number : 417-328-7727
Provider Business Practice Location Address
First Line : 1500 N. OAKLAND AVE
Second Line :
City : BOLIVAR
State : MO
Zip : 65613-3099
Country : US
Telephone Number : 417-328-6334
Fax Number : 417-328-7727
Authorized Official
Title or Position : CEO
Name : DONALD J. BABB
Credential :
Telephone Number : 417-326-6501
Provider Enumeration Date : 05/14/2007
Last Update Date : 10/04/2013

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Directions to “CITIZENS MEMORIAL HEALTH CARE FOUNDATION ” Practice Location

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