Provider Demographics
NPI:1780131771
Name:JOHN FITZGIBBON MEMORIAL HOSPITAL, INC.
Entity type:Organization
Organization Name:JOHN FITZGIBBON MEMORIAL HOSPITAL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO/COO
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-886-7431
Mailing Address - Street 1:2305 SOUTH 65 HIGHWAY BUILDING A
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MO
Mailing Address - Zip Code:65340-3702
Mailing Address - Country:US
Mailing Address - Phone:660-831-3743
Mailing Address - Fax:660-831-3306
Practice Address - Street 1:209 MAIN ST
Practice Address - Street 2:
Practice Address - City:SLATER
Practice Address - State:MO
Practice Address - Zip Code:65349-1411
Practice Address - Country:US
Practice Address - Phone:660-529-2251
Practice Address - Fax:660-831-3348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-07
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO27-57111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty