KIRWOOD MEDICATION ASSISTED TREATMENTS (NPI# 1053953422) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1053953422 |
Entity Type | Organization |
Organization Name | KIRWOOD MEDICATION ASSISTED TREATMENTS |
Practice Address |
111 Prospect Ave Ste 201 Kirkwood MO 63122-6052 |
Practice Telephone | 3146448310 |
Practice Fax Number | 3142936749 |
Mailing Telephone | 3146448310 |
Mailing Fax Number | 3142936749 |
Enumeration Date | 2019-10-17 |
Last Update Date | 2020-05-25 |
Authorized Official Name | DR. GARY HAMMEN (MEMBER) |
Authorized Official Telephone | 3146448310 |
Authorized Official Credential | MD PHD |
Is Organization Subpart | Y |
Parent Organization Name | DR GARY HAMMEN MD PHD LLC |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
Ambulatory Health Care Facilities | ||
Y | 261QR0405X |
Clinic/Center Specialization: Rehabilitation, Substance Use Disorder |
Ambulatory Health Care Facilities |
Other Name | Type Code |
---|---|
Kirkwood Medication Assisted Treatments | Doing Business As Name - Organization |
Street Address |
111 PROSPECT AVE STE 201 |
City | KIRKWOOD |
State | MO |
Zip Code | 63122-6052 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1659933174 | Keela Rushing | Physical Therapist | 439 S Kirkwood Rd Ste 200, Kirkwood, MO 63122 | 2019-07-04 |
1730643461 | Kirkwood Family Dental | Dentist | 333 S Kirkwood Road, Suite 105, Kirkwood, MO 63122 | 2019-01-28 |
1477061166 | Total Access Urgent Care, PC | Clinic/Center | 2980 Dougherty Ferry Rd, Saint Louis, MO 63122 | 2018-01-16 |
1760933469 | Missouri Cvs Pharmacy, L.l.c | Durable Medical Equipment & Medical Supplies | 10820 Manchester Rd, Kirkwood, MO 63122 | 2016-10-18 |
1518321041 | M. Kathleen Blanchard | Counselor | 11042 Manchester Rd., Kirkwood, MO 63122 | 2016-04-11 |
1265801914 | Kim Grega | Counselor | 700 S Kirkwood Rd, Kirkwood, MO 63122 | 2015-09-23 |
1245617943 | Mark Edward Taylor | Dentist | 610 North Geyer, Kirkwood, MO 63122 | 2015-05-01 |
1467843094 | Mary Elizabeth Boomgarden | Physical Therapist | 9645 Big Bend Boulevard, Saint Louis, MO 63122 | 2015-02-18 |
1760725717 | Michael Diller Counseling | Counselor | 144 W Madison Avenue, Kirkwood, MO 63122 | 2013-03-28 |
1427309954 | Anne Marie Delaplain | Dentist | 725 Laclede Station Road, Webster Groves, MO 63122 | 2012-09-24 |
Find all providers in zip 63122 |
Taxonomy Code | 261QR0405X |
Grouping | Ambulatory Health Care Facilities |
Classification | Clinic/Center |
Specialization | Rehabilitation, Substance Use Disorder |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1376973727 | Northbound Treatment Services of Missouri | Clinic/Center | 333 S Kirkwood Rd Ste 303, Kirkwood, MO 63122-6161 | 2013-11-21 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1487179057 | Gateway Foundation, Inc. | Clinic/Center | 1430 Olive St Ste 300, Saint Louis, MO 63103-2303 | 2017-08-04 |
1700233145 | New Beginnings C-star | Clinic/Center | 1408 N Kingshighway Blvd Ste 4, Saint Louis, MO 63113-1426 | 2016-05-16 |
1629432182 | Clark Community Mental Health Center | Clinic/Center | 1701 N Central Ave, Monett, MO 65708 | 2016-04-11 |
1083024061 | Avertest, LLC | Clinic/Center | 4709 Laguardia Dr, Suite 100, Saint Louis, MO 63134 | 2014-04-30 |
1659718609 | Hannibal Council On Alcohol & Drug Abuse | Clinic/Center | 146 Communication Dr, Hannibal, MO 63401-3672 | 2013-05-31 |
1194026765 | Family Counseling Center, Inc. | Clinic/Center | 500 Us Hwy 61 North, Hayti, MO 63851 | 2010-11-12 |
1942501143 | Swope Health Services | Clinic/Center | 3950 E 51st St, Kansas City, MO 64130-3081 | 2010-11-04 |
1750682043 | Black Alcohol/drug Service Information Center | Clinic/Center | 3026 Locust St, Saint Louis, MO 63103-1329 | 2010-11-03 |
1932412186 | Comprehensive Mental Health Services, Inc/renaisance West | Clinic/Center | 5840 Swope Pkwy, Kansas City, MO 64130-4262 | 2010-07-16 |
1609194448 | Southeast Missouri Behavioral Health | Clinic/Center | 216 Piedmont Ave Ste 304, Piedmont, MO 63957-1017 | 2010-05-04 |
Find all providers with the same taxonomy |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.