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DSH260142C JOHN FITZGIBBON MEMORIAL HOSPITAL (Active)
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Main Details
Name
JOHN FITZGIBBON MEMORIAL HOSPITAL
Subdivision Name
JOHN FITZGIBBON MEM HOSPITAL INC - Fitzgibbon Family Health
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH260142C
Medicare Provider Number
260142
Outpatient Facility Provider Number
268731
Additional Details
Current Program Status
Active
Registration Date
1/11/2022
Participating Start Date
4/1/2022
Participating Approval Date
1/14/2022
Last Recertification Date
9/3/2024
Contacts
Authorizing Official
John Fitzgibbon Memorial Hospital
Angy P. Littrell, President & CEO
(660) 831-3251
Primary Contact
John Fitzgibbon Memorial Hospital, Inc.
Cheryl Lynn Cunningham, Compliance Officer
(660) 831-3767
Addresses
Street Address
600 W MORRISON ST
STE 5
FAYETTE, MO 65248-1075
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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