STATE OF MISSOURI (NPI# 1114971702) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114971702 |
| Entity Type | Organization |
| Organization Name | STATE OF MISSOURI |
| Other Organization Name | NEVADA HABILITATION CENTER |
| Practice Address |
2323 N Ash St Nevada MO 64772-1054 |
| Mailing Address |
1706 E Elm St Jefferson City MO 65101-4130 |
| Practice Telephone | 4176677833 |
| Practice Fax Number | 4174481138 |
| Mailing Telephone | 5737513398 |
| Mailing Fax Number | 5735264560 |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2020-08-26 |
| Authorized Official Name | MOLLY JANE BOECKMANN (DIRECTOR OF ADMINISTRATIVE SERVICES) |
| Authorized Official Telephone | 5737514055 |
| Is Organization Subpart | Y |
| Parent Organization Name | STATE OF MISSOURI |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
Allopathic & Osteopathic Physicians | ||
| Y | 208D00000X | General Practice | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | 501499917 | 05 |
| Other Name | Type Code |
|---|---|
| Nevada Habilitation Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437781499 | State of Missouri | Rehabilitation Counselor | 3418 Knipp Dr, Jefferson City, MO 65109-5701 | 2020-02-07 |
| 1275073280 | State of Missouri | General Practice | 1547 W Commerce Drive, Marshall, MO 65340-3907 | 2017-02-24 |
| 1528333085 | State of Missouri | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1000 N Colorado St, Nevada, MO 64772-1618 | 2012-03-16 |
| 1386843621 | State of Missouri | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 15555 Little Blue Rd, Kansas City, MO 64139 | 2007-07-17 |
| 1922207679 | State of Missouri | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 5410 Rinker Rd, Kansas City, MO 64129-2308 | 2007-07-13 |
| 1760681415 | State of Missouri | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1501 N River Blvd, Independence, MO 64050-1760 | 2007-07-13 |
| 1164630463 | State of Missouri | Intermediate Care Facility, Mentally Retarded | 11 Brady Cir, Overland, MO 63114-1110 | 2007-05-18 |
| 1548322605 | State of Missouri | Day Training, Developmentally Disabled Services | 1500 Vandiver Dr Ste 100, Columbia, MO 65202-3932 | 2006-12-15 |
| 1366503153 | State of Missouri | Day Training, Developmentally Disabled Services | 471 E Slater St, Marshall, MO 65340 | 2006-12-13 |
| 1427118033 | State of Missouri | Day Training, Developmentally Disabled Services | 522 Star St, Marshall, MO 65340 | 2006-12-12 |
| Street Address |
2323 N ASH ST |
| City | NEVADA |
| State | MO |
| Zip Code | 64772-1054 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811137516 | State of Missouri | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 2323 N Ash St, Nevada, MO 64772-1054 | 2009-02-20 |
| 1588713853 | Inn T Park | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 2323 N Ash St, Nevada, MO 64772-1054 | 2007-01-09 |
| 1376614701 | State of Missouri | Intermediate Care Facility, Mentally Retarded | 2323 N Ash St, Nevada, MO 64772-1054 | 2006-11-09 |
| 1013940469 | Lewis Shilane | Family Medicine | 2323 N Ash St, Nevada Habilitation Center, Nevada, MO 64772-1054 | 2006-07-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184116170 | Elizabeth Hoang | Dentist | 14054 Us-54, Nevada, MO 64772 | 2018-06-05 |
| 1376056424 | Chelsea Deines | Social Worker | 19940 S. 1481 Road, Nevada, MO 64772 | 2017-11-13 |
| 1558712422 | Ozark Tri County Healthcare Consortium | Dentist | 204 N Cedar, Nevada, MO 64772 | 2016-06-22 |
| 1144605312 | Nevada City Hospital | Clinic/Center | 627 S Ash St Ste B, Nevada, MO 64772 | 2015-07-29 |
| 1205233129 | Julie Ann Parker | Dental Hygienist | 204 North Cedar, Nevada, MO 64772 | 2014-11-20 |
| 1023432101 | Ashley Mckinney | Speech-Language Pathologist | 811 W Hickory, Nevada, MO 64772 | 2014-02-11 |
| 1477975183 | Krc 1505 Health Care Services LLC | Assisted Living Facility | 1505 East Ashland Street, Nevada, MO 64772 | 2014-01-15 |
| 1649520727 | Kathy J Hallam | Registered Nurse | 320 N Mac Boulevard, Nevada, MO 64772 | 2012-09-14 |
| 1396090916 | Emily Lane | Speech-Language Pathologist | 16927 S 1413 Rd, Nevada, MO 64772 | 2012-07-19 |
| 1427385517 | Nevada City Hospital | Clinic/Center | 345 S Barrett Ln., Nevada, MO 64772 | 2009-11-10 |
| Find all providers in zip 64772 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093313124 | Larry Paul Welder | General Practice | 1217 K Ave, Nevada, IA 50201-1943 | 2020-10-12 |
| 1861676520 | Pandu Bonthala | General Practice | 624 J Ave, Nevada, IA 50201-1922 | 2007-12-18 |
| 1063909711 | Caitlin Anne Elmore | General Practice | 900 S Adams St, Nevada, MO 64772-3210 | 2018-04-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790305654 | Remedy Health LLC | General Practice | 37 Doctors Park Ste 3, Cape Girardeau, MO 63703-4903 | 2020-04-21 |
| 1760001598 | Md Sarefin Zaman | General Practice | 2715 W 76 Country Blvd Ste 103, Branson, MO 65616-2344 | 2020-04-12 |
| 1437707551 | Home Docs Medical Associates, LLC | General Practice | 7584 Olive Blvd Ste 204, University City, MO 63130-1600 | 2019-09-02 |
| 1912462912 | Thomas George Brett | General Practice | 800 Missouri 248, Building 3 Suite A, Branson, MO 65616 | 2019-02-04 |
| 1295208403 | Sme Kentucky Psc | General Practice | 5728 Pergola Dr Apt 207, Columbia, MO 65201-2897 | 2019-01-10 |
| 1821579798 | Healthy Schools Missouri LLC | General Practice | 3675 S Noland Rd Ste 200, Independence, MO 64055-3369 | 2018-08-28 |
| 1902300825 | Landmark Medical of Missouri PC | General Practice | 312 Sw Greenwich Dr # 315, Lees Summit, MO 64082-4408 | 2018-03-23 |
| 1740784214 | Bridge Integrative Medicine LLC | General Practice | 305 Nw Englewood Ct Ste 200, Kansas City, MO 64118 | 2018-03-20 |
| 1093218224 | Andrew Jason Doppelt | General Practice | 200 E Southampton Dr Ste 104, Columbia, MO 65203-3032 | 2018-03-14 |
| 1114427606 | Khrystal Robinson | General Practice | 902 E Reed St, Hayti, MO 63851-1243 | 2018-02-20 |
| 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.