Healthcare Provider Details

I. General information

NPI: 1285779330
Provider Name (Legal Business Name): JOHN FITZGIBBON MEMORIAL HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 03/05/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2305 SOUTH 65 HIGHWAY, BUILDING A
MARSHALL MO
65340-3702
US

IV. Provider business mailing address

2305 SOUTH 65 HIGHWAY, BUILDING A
MARSHALL MO
65340-3702
US

V. Phone/Fax

Practice location:
  • Phone: 660-886-7800
  • Fax:
Mailing address:
  • Phone: 660-886-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number27-57
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: NANCY HARRIS
Title or Position: CFO/COO
Credential:
Phone: 660-886-7231