Healthcare Provider Details

I. General information

NPI: 1710904347
Provider Name (Legal Business Name): JOHN FITZGIBBON MEMORIAL HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 01/13/2026
Certification Date: 01/13/2026
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: 660-886-6692
  • Fax: 660-831-3355
Mailing address:
  • Phone: 660-886-7800
  • Fax: 660-831-3328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number27-54
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NANCY HARRIS
Title or Position: CFO/COO
Credential:
Phone: 660-886-7431