NPIMap

Organization Active NPI

State of Missouri

Doing business as Rolla Regional Center

  • Case Management Agency
  • Rolla, MO
National Provider Identifier
1407926140
Registry record updated Oct 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Case Management AgencyTaxonomy code 251B00000X
License
EXEMPT Issued in MO
Legal business name
STATE OF MISSOURI
Doing business as
Rolla Regional Center
Practice address
105 Fairgrounds Rd
Rolla, MO 65401-2909
Phone
(573) 368-2200
Fax
(573) 368-2206
NPI assigned
Nov 9, 2006
Last updated
Oct 27, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
STATE OF MISSOURIAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 27, 2020

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X EXEMPT MO Primary

Addresses

Primary practice location

105 Fairgrounds Rd
Rolla, MO 65401-2909

Mailing address

1706 E Elm St
Jefferson City, MO 65101-4130
Phone (573) 751-3398

Other identifiers 1

IdentifierTypeStateIssuer
151792900MedicaidMO

Other names 1

  • Rolla Regional Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Missouri Tuberculosis Lab104 organizations share this tax ID, including this one
Part of
Missouri Tuberculosis Lab

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

105 Fairgrounds Rd
Rolla, MO 65401
Phone (573) 368-2200

NPI Registry JSON

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

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603756800000",
    "number": "1407926140",
    "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": "105 FAIRGROUNDS RD",
            "city": "ROLLA",
            "state": "MO",
            "postal_code": "654012909",
            "telephone_number": "573-368-2200",
            "fax_number": "573-368-2206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF MISSOURI",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "STATE OF MISSOURI",
        "enumeration_date": "2006-11-09",
        "last_updated": "2020-10-27",
        "certification_date": "2020-10-27",
        "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": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "MO",
            "license": "EXEMPT",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "151792900",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rolla Regional Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Rolla Regional Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rolla, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 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.