Provider Demographics
NPI:1861559817
Name:COMMUNITY MEMORIAL HOSPITAL DISTRICT
Entity type:Organization
Organization Name:COMMUNITY MEMORIAL HOSPITAL DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KADEENA
Authorized Official - Middle Name:
Authorized Official - Last Name:NITCHALS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-476-2121
Mailing Address - Street 1:PO BOX 97
Mailing Address - Street 2:
Mailing Address - City:APPLETON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64724-0097
Mailing Address - Country:US
Mailing Address - Phone:660-476-2121
Mailing Address - Fax:
Practice Address - Street 1:408 E 7TH ST
Practice Address - Street 2:
Practice Address - City:APPLETON CITY
Practice Address - State:MO
Practice Address - Zip Code:64724-1617
Practice Address - Country:US
Practice Address - Phone:660-476-2121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO596051409Medicaid
MO596051409Medicaid