MEDICARE: STATE OF MISSOURI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency	EXEMPT	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275603920
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STATE OF MISSOURI

Provider Business Mailing Address
First Line	:	1706 E ELM ST
Second Line	:
City	:	JEFFERSON CITY
State	:	MO
Zip	:	65101-4130
Country	:	US
Telephone Number	:	573-751-3398
Fax Number	:	573-526-4560

Provider Business Practice Location Address
First Line	:	1500 VANDIVER DR
Second Line	:	SUITE 100
City	:	COLUMBIA
State	:	MO
Zip	:	65202-3932
Country	:	US
Telephone Number	:	573-882-9835
Fax Number	:	573-884-4294

Authorized Official
Title or Position	:	DIRECTOR OF ADMINISTRATIVE SERVICES
Name	:	MOLLY JANE BOECKMANN
Credential	:
Telephone Number	:	573-751-4055

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	10/27/2020

Similar Medicare Providers

1770588972 — DR. WALTER ROBERT PFITZINGER D.D.S, M.S.
Practice Location Address:

1500 VANDIVER DR , STE 104
COLUMBIA, MO
65202-3932

Practice Phone: 573-814-1694
Practice Fax: 573-814-2845

1548322605 — STATE OF MISSOURI
Practice Location Address:

1500 VANDIVER DR STE 100
COLUMBIA, MO
65202-3932

Practice Phone: 573-882-9835
Practice Fax: 573-884-4294

1164622395 — WALTER R. PFITZINGER D.D.S,, P.C.
Practice Location Address:

1500 VANDIVER DR , SUITE 104
COLUMBIA, MO
65202-3932

Practice Phone: 573-814-1694
Practice Fax: 573-814-2845

1053568865 — MICHAEL S. TODD D.M.D., LLC
Practice Location Address:

1500 VANDIVER DR , SUITE 104
COLUMBIA, MO
65202-3932

Practice Phone: 573-814-1694
Practice Fax: 573-814-2845

1225999659 — LAMELOT HOME CARE LLC
Practice Location Address:

2240 N FEDERAL DR
COLUMBIA, MO
65202-5650

Practice Phone: 210-750-0039
Practice Fax:

1437151750 — DR. MICHAEL SEAN TODD DMD
Practice Location Address:

1500 VANDIVER , SUITE 104
COLUMBIA, MO
65202

Practice Phone: 573-814-1694
Practice Fax: 573-814-2845

Directions to “STATE OF MISSOURI ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.