Provider Demographics
NPI:1063442887
Name:BOLIVAR MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:BOLIVAR MEDICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:D
Authorized Official - Last Name:FOLLIS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, BC
Authorized Official - Phone:417-326-4000
Mailing Address - Street 1:714 N POMME DE TERRE AVE
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:MO
Mailing Address - Zip Code:65613-1241
Mailing Address - Country:US
Mailing Address - Phone:417-326-4000
Mailing Address - Fax:417-326-6400
Practice Address - Street 1:714 N POMME DE TERRE AVE
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:MO
Practice Address - Zip Code:65613-1241
Practice Address - Country:US
Practice Address - Phone:417-326-4000
Practice Address - Fax:417-326-6400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical GeneticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO=========OtherTAX ID