NPIMap

Organization Active NPI

Missouri State University

  • Community Health Clinic/Center
  • Springfield, MO
National Provider Identifier
1477893907
Registry record updated Feb 20, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Clinic/CenterTaxonomy code 261QC1500X
License
2013003462 Issued in MO
Legal business name
MISSOURI STATE UNIVERSITY
Doing business as
The Kitchen Clinic
Practice address
1630 N Jefferson Ave
Springfield, MO 65803-2819
Phone
(417) 837-1504
Fax
(417) 837-1545
NPI assigned
Feb 20, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2013

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

Authorized official

Name
Mark Bower, M.D.NPI 1265479984
Title
Physician, Medical Director
Phone
(417) 837-1500

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X 2013003462 MO Primary

Addresses

Primary practice location

1630 N Jefferson Ave
Springfield, MO 65803-2819

Mailing address

Missouri State Department of Nursing
901 S. National Avenue
Springfield, MO 65897-0001
Phone (417) 836-5310

Other names 1

  • The Kitchen Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Missouri State University Athletic Medical and Rehabilitation Services4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

1630 N Jefferson Ave
Springfield, MO 65803
Phone (417) 837-1504

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1361318400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1361318400000",
    "number": "1477893907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "MISSOURI STATE DEPARTMENT OF NURSING",
            "address_2": "901 S. NATIONAL AVENUE",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658970001",
            "telephone_number": "417-836-5310",
            "fax_number": "417-836-5484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1630 N JEFFERSON AVE",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658032819",
            "telephone_number": "417-837-1504",
            "fax_number": "417-837-1545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSOURI STATE UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-02-20",
        "last_updated": "2013-02-20",
        "status": "A",
        "authorized_official_last_name": "BOWER",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "PHYSICIAN, MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "417-837-1500",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "MO",
            "license": "2013003462",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Kitchen Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Feb 20, 2013; 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.