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Contact Information

STATE OF MISSOURI
600 E 5TH ST
FULTON, MO65251-1753
 Phone: 573-592-4100
 Fax: 573-592-3000
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Psychiatry

2084P0800X 26 Physician/Psychiatry
 

Clinical

103TC0700X 62 Psychologist, Clinical
 

Clinical

1041C0700X 80 Licensed Clinical Social Worker
 

Family Medicine

207Q00000X 08 Physician/Family Practice
 

Internal Medicine

207R00000X 11 Physician/Internal Medicine
 

Optometrist

152W00000X 41 Optometry
 

Podiatrist

213E00000X 48 Podiatry
 

Psychologist

103T00000X 62 Psychologist, Clinical
Indicates primary specialty

NPI Profile & details for STATE OF MISSOURI

NPI Number 1164477873
LBN Legal business name STATE OF MISSOURI
Authorized official MOLLY BOECKMANN - (DIRECTOR OF ADMINISTRATIVE SERVICES)
Entity Organization
Organization subpart 1 Yes
Enumeration date 05/23/2006
Last updated 08/28/2020 - About 6 years ago
Identifiers
MO Medicaid 500490008
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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