DataLabs
datalabs.health made in the usa
DataLabs Facebook Wall   Like   Follow DataLabs on Twitter   Tweet  
Contact us Sign in |  Documentation | 
NPI Code Detail

MEDICARE: STATE OF MISSOURI

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
1103TC0700XClinical Psychologist
2207Q00000XFamily Medicine Physician
32084P0800XPsychiatry Physician

Other Identifiers

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

General Provider Information

NPI Number : 1386691657
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 : 3505 FREDERICK AVE
Second Line :
City : SAINT JOSEPH
State : MO
Zip : 64506-2914
Country : US
Telephone Number : 816-387-2300
Fax Number : 816-387-2329
Authorized Official
Title or Position : DIRECTOR OF ADMINISTRATIVE SERVICES
Name : MOLLY JANE BOECKMANN
Credential :
Telephone Number : 573-751-4055
Provider Enumeration Date : 05/30/2006
Last Update Date : 09/03/2020

Similar Medicare Providers

1033116579 — DR. STEVEN CLARK STONER PHARM.D., BCPP
Practice Location Address:
3505 FREDERICK AVE , NMPRC
SAINT JOSEPH, MO
64506-2914
Practice Phone: 816-387-2580
Practice Fax: 816-387-2391
1538169958 — MR. LEONARD V RAMLATCHMAN RPH, BCPP
Practice Location Address:
3505 FREDERICK AVE
SAINT JOSEPH, MO
64506-2914
Practice Phone: 816-387-2564
Practice Fax: 816-387-2391
1104879444 — STATE OF MISSOURI
Practice Location Address:
3505 FREDERICK AVE
SAINT JOSEPH, MO
64506-2914
Practice Phone: 816-387-2300
Practice Fax: 816-387-2329
1467499772 — DR. JAMES REYNOLDS M.D.
Practice Location Address:
3505 FREDERICK AVE
SAINT JOSEPH, MO
64506-2914
Practice Phone: 816-387-2300
Practice Fax: 816-387-2329
1457458432 — DR. JEANETTE MARITZA SIMMONS PSY.D.
Practice Location Address:
3505 FREDERICK AVE
SAINT JOSEPH, MO
64506-2914
Practice Phone: 816-387-2300
Practice Fax: 816-387-2769
1619060423 — DR. KIT L WELSH PSY.D.
Practice Location Address:
3505 FREDERICK AVE
SAINT JOSEPH, MO
64506-2914
Practice Phone: 816-387-2300
Practice Fax:

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.