CITIZENS MEMORIAL HOSPITAL DISTRICT (NPI# 1932545043) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1932545043 |
| Entity Type | Organization |
| Organization Name | CITIZENS MEMORIAL HOSPITAL DISTRICT |
| Other Organization Name | CMH PORTABLE MOBILE XRAY |
| Practice Address |
1500 N Oakland Ave Bolivar MO 65613-3011 |
| Practice Telephone | 4173287289 |
| Practice Fax Number | 4173286237 |
| Mailing Telephone | 4173287289 |
| Mailing Fax Number | 4173286237 |
| Enumeration Date | 2013-05-15 |
| Last Update Date | 2013-05-15 |
| Authorized Official Name | DONALD J BABB (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Telephone | 4173286501 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 335V00000X | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 313-30 | MO | Suppliers |
| Other Name | Type Code |
|---|---|
| CMH PORTABLE MOBILE XRAY | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053712109 | Citizens Memorial Hospital District | Pharmacy | 1301-b North Oakland, Bolivar, MO 65613 | 2014-09-09 |
| 1619303823 | Citizens Memorial Hospital District | Durable Medical Equipment & Medical Supplies | 1500 N Oakland Ave, Bolivar, MO 65613-3011 | 2013-09-19 |
| 1154598795 | Citizens Memorial Hospital District | Durable Medical Equipment & Medical Supplies | 1500 N Oakland Ave, Bolivar, MO 65613-3011 | 2008-05-13 |
| 1558548818 | Citizens Memorial Hospital District | Anesthesiology | 1500 N Oakland Ave, Bolivar, MO 65613-3011 | 2008-01-29 |
| 1003945213 | Citizens Memorial Hospital District | Psychiatric Unit | 1500 N Oakland Ave, Bolivar, MO 65613-3011 | 2007-03-05 |
| 1841328424 | Citizens Memorial Hospital District | Medicare Defined Swing Bed Unit | 1500 N Oakland Ave, Bolivar, MO 65613-3011 | 2007-03-02 |
| 1003981549 | Citizens Memorial Hospital District | General Acute Care Hospital | 1500 N Oakland Ave, Bolivar, MO 65613-3011 | 2006-11-21 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | CITIZENS MEMORIAL HOSPITAL DISTRICT OF POLK COUNTY | 1500 N Oakland Ave, Bolivar, MO 65613-3011 |
| Street Address |
1500 N OAKLAND AVE |
| City | BOLIVAR |
| State | MO |
| Zip Code | 65613-3011 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992705305 | Bryan E Flueckiger | Psychiatry & Neurology | 1500 N Oakland Ave, Bolivar, MO 65613-3011 | 2005-07-28 |
| 1750994281 | Lynetta S Smith | Dietitian, Registered | 1500 N Oakland Ave, Bolivar, MO 65613-3099 | 2020-08-25 |
| 1689282485 | Austin Gott | Dietitian, Registered | 1500 N Oakland Ave, Bolivar, MO 65613-3011 | 2020-07-17 |
| 1275141129 | Mesha Cowan | Dietitian, Registered | 1500 N Oakland Ave, Bolivar, MO 65613-3099 | 2020-07-16 |
| 1700427358 | Micah Miller | Physician Assistant | 1500 N Oakland Ave, Bolivar, MO 65613-3099 | 2019-10-04 |
| 1619438009 | Kristina Vance | Occupational Therapist | 1500 N Oakland Ave, Bolivar, MO 65613-3011 | 2019-03-27 |
| 1417420381 | Melissa Sue Moores | Social Worker | 1500 N Oakland Ave, Bolivar, MO 65613-3099 | 2019-01-03 |
| 1982171625 | Kimberly Doolin | Registered Nurse | 1500 N Oakland Ave, Bolivar, MO 65613-3011 | 2018-10-31 |
| 1356837694 | Katelynn Stewart | Specialist/Technologist | 1500 N Oakland Ave, Bolivar, MO 65613-3099 | 2018-07-10 |
| 1902315401 | Daniel J Ferguson | Nurse Practitioner | 1500 N Oakland Ave, Bolivar, MO 65613-3011 | 2017-09-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891301552 | Casablanca Care Center, LLC | Home Health | 524 S. Albany Avenue, Bolivar, MO 65613 | 2020-09-18 |
| 1669087045 | Revive Medical LLC | Durable Medical Equipment & Medical Supplies | 5000, S Scenic, Bolivar, MO 65613 | 2020-09-11 |
| 1669097119 | Melanie Nicole Beckham | Nurse Practitioner | 1100 South Springfield Ave, Suite B, Bolivar, MO 65613 | 2020-06-10 |
| 1932754744 | Caitlin M Williams | Specialist/Technologist | 1260 S Pike Avenue, Bolivar, MO 65613 | 2019-08-08 |
| 1073022406 | Jacquelyn Rose Kemnic | Dietitian, Registered | Heart Center, 1500 N Oakland Ave, Willard, MO 65613 | 2017-09-28 |
| 1164897161 | Ozarks Resource Group | Clinic/Center | 203 E. Broadway St., Bolivar, MO 65613 | 2015-12-02 |
| 1962895292 | Professional Christian Counseling | Counselor | 4888 S 139th Road, Bolivar, MO 65613 | 2015-03-11 |
| 1073916573 | Scott Leslie Dennis | Physician Assistant | 1500 North Oakland Ave, Citizens Memorial Hospital, Bolivar, MO 65613 | 2014-09-29 |
| 1053712109 | Citizens Memorial Hospital District | Pharmacy | 1301-b North Oakland, Bolivar, MO 65613 | 2014-09-09 |
| 1740680453 | Jamee M Stimpson | Occupational Therapist | 454 S. Main Avenue, Bolivar, MO 65613 | 2014-08-29 |
| Find all providers in zip 65613 | ||||
| Taxonomy Code | 335V00000X |
| Grouping | Suppliers |
| Classification | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier |
| A supplier that provides one or more of the following portable services, including but not limited to, x-ray, electrocardiogram (EKG), long-term EKG (Holter Monitor), bone densitometry, sonography, and other imaging services in accordance with all state and federal requirements, under the general supervision of a qualified physician. All necessary resources are transported to the patient's location where the services are performed. |
| Notes: Source: National Uniform Claim Committee, 2015 [1/1/2016: title and definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952946378 | Mjm Diagnostics LLC | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 1301 Oak St Ste 713, Kansas City, MO 64106-2913 | 2019-11-08 |
| 1861986176 | Biomedical Imaging LLC | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 3450 Bridgeland Dr Ste F, Bridgeton, MO 63044-2605 | 2018-06-20 |
| 1508225715 | Missouri Diagnostic Services, LLC | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 1517 Copper Rd, Holts Summit, MO 65043-2033 | 2016-02-16 |
| 1891125142 | Midwest Mobile Imaging | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 408 Washington Ave Ste 107, West Plains, MO 65775-3404 | 2013-11-23 |
| 1265786305 | Prowave Diagnostics LLC | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 238 Peach Ln, Ridgedale, MO 65739-4182 | 2012-10-27 |
| 1720239767 | American Mobile X-ray, LLC | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 221 Adair Road, Branson, MO 65615-7865 | 2008-10-08 |
| 1528214913 | Innovative Mobile Services LLC | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 202 Miller Way, Monett, MO 65708-8336 | 2008-08-18 |
| 1790959773 | Digital X Mobile, Inc. | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 13 Cedar Crest Dr, Fenton, MO 63026-5041 | 2008-04-21 |
| 1376749812 | Mobile X-ray Services LLC | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 3050 N 20th St, Ozark, MO 65721-5925 | 2007-06-22 |
| 1720106958 | Gateway Sonographics, Inc. | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 1115 James Dr, Imperial, MO 63052-2343 | 2007-03-26 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.