State of Missouri

NPI #1194936971 in El Dorado Springs, Missouri

Provider Information

NPI Number: 1194936971
Entity Type: Organization
Organization Name: State of Missouri
Subpart: Yes (part of a larger organization)
Parent Organization: STATE OF MISSOURI
Primary Specialty: Case Management
Enumeration Date: May 24, 2007
Last Updated: Aug 28, 2020

Practice Location

Address: 1301 INDUSTRIAL PKWY E
City: El Dorado Springs
State: Missouri
ZIP Code: 64744-6263
Phone: (417) 876-1004

Authorized Official

Name: MOLLY JANE BOECKMANN
Title: DIRECTOR OF ADMINISTRATIVE SERVICES
Phone: (573) 751-4055

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Case Management	251B00000X	Primary

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