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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
1283Q00000XPsychiatric Hospital

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 : 1578518239
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 : 5300 ARSENAL ST
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63139-1463
Country : US
Telephone Number : 314-877-6500
Fax Number : 314-877-5982
Authorized Official
Title or Position : DIRECTOR OF ADMINISTRATIVE SERVICES
Name : MOLLY JANE BOECKMANN
Credential :
Telephone Number : 573-751-4055
Provider Enumeration Date : 05/23/2006
Last Update Date : 12/01/2020

Similar Medicare Providers

1427002013 — STATE OF MISSOURI
Practice Location Address:
5300 ARSENAL ST
SAINT LOUIS, MO
63139-1463
Practice Phone: 314-644-8000
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Practice Location Address:
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1275610453 — LILY RAYMOND PHD
Practice Location Address:
5300 ARSENAL ST
SAINT LOUIS, MO
63139-1463
Practice Phone: 314-877-6132
Practice Fax:
1689722951 — PRAVEEN SRISATYA NIMMAGADDA MD
Practice Location Address:
5300 ARSENAL ST
SAINT LOUIS, MO
63139-1463
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Practice Fax:
1922157056 — DR. LORI DEROSEAR D.O.
Practice Location Address:
5300 ARSENAL ST
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Directions to “STATE OF MISSOURI ” Practice Location

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