Republic R-III

Primary specialty

Local Education Agency (LEA)Taxonomy code 251300000X

Legal business name

REPUBLIC R-III

Practice address

518 N Hampton Ave
Republic, MO 65738-1323

Phone

(417) 732-3605

Fax

(417) 732-3609

NPI assigned

Feb 6, 2007

Organization subpart

No

Name

Kilina Goldenberg

Title

District Coordinator

Phone

(417) 732-3605

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jun 15, 2016.

{
    "created_epoch": "1170720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1465948800000",
    "number": "1164561890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "518 N HAMPTON AVE",
            "city": "REPUBLIC",
            "state": "MO",
            "postal_code": "657381323",
            "telephone_number": "417-732-3605",
            "fax_number": "417-732-3609"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "518 N HAMPTON AVE",
            "city": "REPUBLIC",
            "state": "MO",
            "postal_code": "657381323",
            "telephone_number": "417-732-3605",
            "fax_number": "417-732-3609"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REPUBLIC R-III",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-06",
        "last_updated": "2016-06-15",
        "status": "A",
        "authorized_official_last_name": "GOLDENBERG",
        "authorized_official_first_name": "KILINA",
        "authorized_official_title_or_position": "DISTRICT COORDINATOR",
        "authorized_official_telephone_number": "417-732-3605"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251300000X",
            "taxonomy_group": "",
            "desc": "Local Education Agency (LEA)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "506157403",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Charise A Price, BSDC
• Regional Services
• Republic Family Medical Walk-in Clinics Inc
• Republic Family Medicine, LLC
• Republic Hearing Care LLC
• Amy Sue Ridenour, MSN, FNP-C
• Riverbranch Healthcare, LLC
• Madelyn Grace Robinson, PTA
• Amanda Russell
• Rachel Sakuda, LMSW

• All providers in Republic, MO
• Local Education Agency (LEA) in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2016; 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.