NPIMap

Organization Active NPI

Independence Center

  • Community/Behavioral Health Agency
  • Saint Louis, MO
National Provider Identifier
1558494286
Registry record updated Jun 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
INDEPENDENCE CENTER
Practice address
4245 Forest Park Ave
Saint Louis, MO 63108-2810
Phone
(314) 880-5415
NPI assigned
Mar 13, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2022

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

Authorized official

Name
Mrs. Patricia Holmes
Title
Executive Director
Phone
(314) 880-5415

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

4245 Forest Park Ave
Saint Louis, MO 63108-2810

Mailing address

8675 Olive Blvd
Saint Louis, MO 63132-2503
Phone (314) 373-5187

Other identifiers 1

IdentifierTypeStateIssuer
876173501MedicaidMO

National Provider Directory

National Provider Directory
Tax ID family
Independence Center6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

NPI Registry JSON

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

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1656288000000",
    "number": "1558494286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8675 OLIVE BLVD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631322503",
            "telephone_number": "314-373-5187",
            "fax_number": "314-367-5626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4245 FOREST PARK AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631082810",
            "telephone_number": "314-880-5415"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDEPENDENCE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-13",
        "last_updated": "2022-06-27",
        "certification_date": "2022-06-27",
        "status": "A",
        "authorized_official_last_name": "HOLMES",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "314-880-5415",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "876173501",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2022; 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.