Provider Demographics
NPI:1740277573
Name:FITZGIBBON HEALTH SERVICES
Entity type:Organization
Organization Name:FITZGIBBON HEALTH SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:LITTRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-886-7231
Mailing Address - Street 1:2506 LINDEN TREE PKWY
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MO
Mailing Address - Zip Code:65340-0017
Mailing Address - Country:US
Mailing Address - Phone:660-886-9676
Mailing Address - Fax:660-831-3332
Practice Address - Street 1:2506 LINDEN TREE PKWY
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MO
Practice Address - Zip Code:65340-0017
Practice Address - Country:US
Practice Address - Phone:660-886-9676
Practice Address - Fax:660-831-3332
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FITZGIBBON HEALTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-06
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO029265314000000X
MO041620314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO108933409Medicaid
MO265688Medicare Oscar/Certification