Organization
CITIZENS MEMORIAL HEALTHCARE CLINICS
Active
Other names
CMH Foot & Ankle Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
BRENDA K SHEPHERD (PROVIDER APPLICATION SPECIALIST)
(417) 328-7705
Entity
Organization
Contact information
Practice address
1630 KILLINGSWORTH AVE, BOLIVAR, MO 65613-2282
(417) 326-6200
(417) 777-7463
Mailing address
PO BOX 939, BOLIVAR, MO 65613-0939
(417) 777-6911
(417) 326-6936
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
313-25
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
626365001
—
MO
Enumeration date
08/04/2008
Last updated
08/04/2008
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