NPIMap

Organization Active NPI

Missouri State University Athletic Medical and Rehabilitation Services

  • Clinic/Center
  • Springfield, MO
National Provider Identifier
1649341272
Registry record updated Apr 1, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
MISSOURI STATE UNIVERSITY ATHLETIC MEDICAL AND REHABILITATION SERVICES
Practice address
901 S National Ave
Springfield, MO 65897-0027
Phone
(417) 836-5461
Fax
(417) 836-6101
NPI assigned
Nov 13, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2010

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

Authorized official

Name
Mr. James Thomas Penkalski, ATC
Title
Director
Phone
(417) 836-5461

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

901 S National Ave
Springfield, MO 65897-0027

Mailing address

901 S National Ave
Springfield, MO 65897-0027
Phone (417) 836-5461

Other names 1

  • Missouri State University Athletic Training Services Former legal business name

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.

NPI Registry JSON

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

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1270080000000",
    "number": "1649341272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 S NATIONAL AVE",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658970027",
            "telephone_number": "417-836-5461",
            "fax_number": "417-836-6101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 S NATIONAL AVE",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658970027",
            "telephone_number": "417-836-5461",
            "fax_number": "417-836-6101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSOURI STATE UNIVERSITY ATHLETIC MEDICAL AND REHABILITATION SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-13",
        "last_updated": "2010-04-01",
        "status": "A",
        "authorized_official_last_name": "PENKALSKI",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "THOMAS",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "417-836-5461",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "ATC"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Missouri State University Athletic Training Services",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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 Apr 1, 2010; 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.