NPIMap

Organization Active NPI

Southeast Missouri State University Autism Center

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Cape Girardeau, MO
National Provider Identifier
1699020503
Registry record updated Jul 17, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X
Legal business name
SOUTHEAST MISSOURI STATE UNIVERSITY AUTISM CENTER
Practice address
611 N Fountain St
Cape Girardeau, MO 63701-7244
Phone
(573) 986-4985
Fax
(573) 986-4994
NPI assigned
Jul 17, 2012
Last updated
Jul 17, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2012

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

Authorized official

Name
Connie L Hebert, MS ED.
Title
Director
Phone
(573) 986-4985

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X Primary

Addresses

Primary practice location

611 N Fountain St
Cape Girardeau, MO 63701-7244

Mailing address

1 University PLZ
Mailstop 9450
Cape Girardeau, MO 63701-4710
Phone (573) 986-4985

Other identifiers 1

IdentifierTypeStateIssuer
1316261621MedicaidMO

National Provider Directory

National Provider Directory

Locations

1 University Plz
#9450
Cape Girardeau, MO 63701

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1342483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1342483200000",
    "number": "1699020503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 UNIVERSITY PLZ",
            "address_2": "MAILSTOP 9450",
            "city": "CAPE GIRARDEAU",
            "state": "MO",
            "postal_code": "637014710",
            "telephone_number": "573-986-4985",
            "fax_number": "573-986-4994"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 N FOUNTAIN ST",
            "city": "CAPE GIRARDEAU",
            "state": "MO",
            "postal_code": "637017244",
            "telephone_number": "573-986-4985",
            "fax_number": "573-986-4994"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST MISSOURI STATE UNIVERSITY AUTISM CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-17",
        "last_updated": "2012-07-17",
        "status": "A",
        "authorized_official_last_name": "HEBERT",
        "authorized_official_first_name": "CONNIE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "573-986-4985",
        "authorized_official_credential": "MS ED."
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1316261621",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cape Girardeau, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2012; 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.