MEDICARE: CITIZENS MEMORIAL HEALTHCARE

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
1	261QP2300X	Primary Care Clinic/Center
2	261QR1300X	Rural Health Clinic/Center

General Provider Information

NPI Number	:	1942414610
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITIZENS MEMORIAL HEALTHCARE

Provider Business Mailing Address
First Line	:	1500 N OAKLAND AVE
Second Line	:
City	:	BOLIVAR
State	:	MO
Zip	:	65613-3011
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1195 N OAKLAND AVE
Second Line	:	SUITE 2
City	:	BOLIVAR
State	:	MO
Zip	:	65613-8095
Country	:	US
Telephone Number	:	417-777-2121
Fax Number	:	417-777-2854

Authorized Official
Title or Position	:	CFO
Name	:	RENEE MARIE MEYER
Credential	:
Telephone Number	:	417-328-6258

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	10/21/2025

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