NPIMap

Organization Active NPI

Boys and Girls Town Missouri

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Springfield, MO
National Provider Identifier
1013086842
Registry record updated Oct 23, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
License
2002002751 Issued in MO
Legal business name
BOYS AND GIRLS TOWN MISSOURI
Practice address
1212 W Lombard St
Springfield, MO 65806-2720
Phone
(417) 865-1646
Fax
(417) 866-1483
NPI assigned
Nov 7, 2006
Last updated
Oct 23, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Greg Shank, MSW,NPI 1821457557
Title
Therapist
Phone
(417) 865-1646

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X 2002002751 MO Primary

Addresses

Primary practice location

1212 W Lombard St
Springfield, MO 65806-2720

Mailing address

412 Cardinal CT
Nixa, MO 65714-8848
Phone (417) 725-8684

Other identifiers 1

IdentifierTypeStateIssuer
494901309MedicaidMO

National Provider Directory

National Provider Directory
Tax ID family
Great Circle14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

Organizations that report the same tax identification number in the National Provider Directory.

View all 13

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1256256000000",
    "number": "1013086842",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "412 CARDINAL CT",
            "city": "NIXA",
            "state": "MO",
            "postal_code": "657148848",
            "telephone_number": "417-725-8684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1212 W LOMBARD ST",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658062720",
            "telephone_number": "417-865-1646",
            "fax_number": "417-866-1483"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOYS AND GIRLS TOWN MISSOURI",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-07",
        "last_updated": "2009-10-23",
        "status": "A",
        "authorized_official_last_name": "SHANK",
        "authorized_official_first_name": "GREG",
        "authorized_official_title_or_position": "THERAPIST",
        "authorized_official_telephone_number": "417-865-1646",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MSW,"
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "MO",
            "license": "2002002751",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "494901309",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.