Provider Demographics
NPI:1952611436
Name:JOHN FITZGIBBON MEMORIAL HOSPITAL INC.
Entity Type:Organization
Organization Name:JOHN FITZGIBBON MEMORIAL HOSPITAL INC.
Other - Org Name:AKEMAN MCBURNEY HEALTH CLINIC
Other - Org Type:Doing Business As
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:680-886-7431
Mailing Address - Street 1:420 WEST FRONT STREET
Mailing Address - Street 2:
Mailing Address - City:SLATER
Mailing Address - State:MO
Mailing Address - Zip Code:65349-1328
Mailing Address - Country:US
Mailing Address - Phone:660-529-2251
Mailing Address - Fax:660-831-3348
Practice Address - Street 1:420 WEST FRONT STREET
Practice Address - Street 2:
Practice Address - City:SLATER
Practice Address - State:MO
Practice Address - Zip Code:65349-1328
Practice Address - Country:US
Practice Address - Phone:660-529-2251
Practice Address - Fax:660-831-3348
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOHN FITZGIBBON MEMORIAL HOSPITAL INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-10-18
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1952611436Medicaid
MO1952611436Medicaid