NPIMap

Organization Active NPI

College Skyline Center LLC

  • Clinic/Center
  • Joplin, MO
National Provider Identifier
1598764110
Registry record updated May 4, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
COLLEGE SKYLINE CENTER LLC
Practice address
1230 N Duquesne Rd
Joplin, MO 64801-1509
Phone
(417) 782-1443
Fax
(417) 782-3240
NPI assigned
Jul 15, 2005
Last updated
May 4, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 4, 2017

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

Authorized official

Name
Mrs. Tracy Eddington
Title
Administration
Phone
(417) 782-1443

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

1230 N Duquesne Rd
Joplin, MO 64801-1509

Mailing address

1230 N Duquesne Rd
Joplin, MO 64801-1509
Phone (417) 782-1443

Other identifiers 1

IdentifierTypeStateIssuer
507593408MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070309000442 MO Part B Supplier - Clinic/Group Practice 0749383842 Receives reassigned benefits from 19 practitioners
Practice locations: Joplin, MO

National Provider Directory

National Provider Directory

Locations

1230 N Duquesne Rd
Joplin, MO 64801
Phone (417) 782-1443

Practitioners & affiliated clinicians

Practitioners 45

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 45

NPI Registry JSON

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

{
    "created_epoch": "1121385600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1493856000000",
    "number": "1598764110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1230 N DUQUESNE RD",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "648011509",
            "telephone_number": "417-782-1443",
            "fax_number": "417-782-3240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1230 N DUQUESNE RD",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "648011509",
            "telephone_number": "417-782-1443",
            "fax_number": "417-782-3240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLEGE SKYLINE CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-15",
        "last_updated": "2017-05-04",
        "status": "A",
        "authorized_official_last_name": "EDDINGTON",
        "authorized_official_first_name": "TRACY",
        "authorized_official_title_or_position": "ADMINISTRATION",
        "authorized_official_telephone_number": "417-782-1443",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "507593408",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Joplin, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.