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General NPI Number Information
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NPI Number | 1639384597
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Entity Type | Organization
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Legal Business Name | CITIZENS MEMORIAL HEALTH CARE FOUNDATION
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 10/04/2013
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Provider Practice Location Address
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Address Line | 1500 N. OAKLAND AVE
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City | BOLIVAR
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State | MO
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Zip | 65613-3099
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Country | US
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Telephone | 417-328-6334
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Fax | 417-328-7727
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Provider Business Mailing Address
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Address Line | 1500 N. OAKLAND AVE
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City | BOLIVAR
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State | MO
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Zip | 65613-3099
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Country | US
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Telephone | 417-326-6334
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Fax | 417-328-7727
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Authorized Official
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Title or Position | CEO
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Name | DONALD J. BABB
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Credential |
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Telephone | 417-326-6501
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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