Provider Demographics
NPI:1922212919
Name:CMH FOOT AND ANKLE CLINIC
Entity Type:Organization
Organization Name:CMH FOOT AND ANKLE CLINIC
Other - Org Name:CITIZENS MEMORIAL HEALTHCARE CLINICS
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATIVE SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WESTMARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-328-6545
Mailing Address - Street 1:1630 KILLINGSWORTH AVE
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:BOLIVAR
Mailing Address - State:MO
Mailing Address - Zip Code:65613-2282
Mailing Address - Country:US
Mailing Address - Phone:417-326-6200
Mailing Address - Fax:
Practice Address - Street 1:1630 KILLINGSWORTH AVE
Practice Address - Street 2:SUITE 2A
Practice Address - City:BOLIVAR
Practice Address - State:MO
Practice Address - Zip Code:65613-2282
Practice Address - Country:US
Practice Address - Phone:417-326-6200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty