=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427480995
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CITIZENS MEMORIAL HOSPITAL DISTRICT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/06/2013
-----------------------------------------------------
Last Update Date | 01/31/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 315 S ASH ST
-----------------------------------------------------
City | BUFFALO
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65622-8705
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-345-2321
-----------------------------------------------------
Fax | 417-345-8837
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1500 N OAKLAND AVE
-----------------------------------------------------
City | BOLIVAR
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65613-3011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-328-6258
-----------------------------------------------------
Fax | 417-328-6242
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | RENEE MARIE MEYER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 417-328-6258
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------