Provider Demographics
NPI:1730182478
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 S 65 HIGHWAY
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:660-886-7431
Mailing Address - Fax:660-886-9001
Practice Address - Street 1:2305 S 65 HIGHWAY
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MO
Practice Address - Zip Code:65340-3702
Practice Address - Country:US
Practice Address - Phone:660-886-7431
Practice Address - Fax:660-886-9001
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOHN FITZGIBBON MEMORIAL HOSPITAL INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-05-26
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO27-56282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAXHSP30930Medicaid
CO95027280Medicaid
MO010636405Medicaid
AR113880105Medicaid
FL097388200Medicaid
MO1730182478Medicaid
KY01400779Medicaid
IA0900563Medicaid
KS100100230AMedicaid
CO95027280Medicaid