State of Missouri

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

Legal business name

STATE OF MISSOURI

Doing business as

Southwest MO Psychiatric Rehabilitation Center

Practice address

1301 Industrial Pkwy E
El Dorado Springs, MO 64744-6263

Phone

(417) 876-1002

Fax

(417) 876-1004

NPI assigned

May 19, 2006

Last updated

Aug 26, 2020By the provider in NPPES

Organization subpart

Yes

Parent organization

STATE OF MISSOURIAs reported in NPPES

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

Authorized official

Name

Molly Jane Boeckmann

Title

Director of Administrative Services

Phone

(573) 751-4055

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Southwest MO Psychiatric Rehabilitation Center Doing business as

Part of

Missouri Tuberculosis Lab

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

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598400000000",
    "number": "1396798237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1706 E ELM ST",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651014130",
            "telephone_number": "573-751-3398",
            "fax_number": "573-526-4560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 INDUSTRIAL PKWY E",
            "city": "EL DORADO SPRINGS",
            "state": "MO",
            "postal_code": "647446263",
            "telephone_number": "417-876-1002",
            "fax_number": "417-876-1004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF MISSOURI",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "STATE OF MISSOURI",
        "enumeration_date": "2006-05-19",
        "last_updated": "2020-08-26",
        "certification_date": "2020-08-26",
        "status": "A",
        "authorized_official_last_name": "BOECKMANN",
        "authorized_official_first_name": "MOLLY",
        "authorized_official_middle_name": "JANE",
        "authorized_official_title_or_position": "DIRECTOR OF ADMINISTRATIVE SERVICES",
        "authorized_official_telephone_number": "573-751-4055"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "501499909",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southwest MO Psychiatric Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Southwest MO Psychiatric Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jenny Marinda Sibley
• Skills Unlimited Inc
• Shelly Ann Sorden, FNP-C
• St Johns Clinic Inc (SJC-El Dorado Springs)
• State of Missouri (Southwest Missouri Psychiatric Rehabilitation Center)
• State of Missouri (Southwest Missouri Psychiatric Rehabilitiation Center)
• State of Missouri (Southwest Missouri Psychiatric Rehabilitation Center)
• Jennifer Strickler
• Debbie Taylor, LPN
• Teddi Taylor

• Psychiatry Physician in El Dorado Springs, MO
• Providers in El Dorado Springs, MO by specialty
• Psychiatry Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2020; 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.