NPIMap

Organization Active NPI

Mark Twain Association for Mental Health, Inc.

Doing business as Mark Twain Behavioral Health

  • Community/Behavioral Health Agency
  • Hannibal, MO
National Provider Identifier
1700933363
Registry record updated Jan 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
MARK TWAIN ASSOCIATION FOR MENTAL HEALTH, INC.
Doing business as
Mark Twain Behavioral Health
Practice address
154 Forrest Dr
Hannibal, MO 63401-5511
Phone
(573) 221-2120
Fax
(573) 221-4380
NPI assigned
Jan 5, 2007
Last updated
Jan 5, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2021

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

Authorized official

Name
Mr. Michael Gene Cantrell, MBA
Title
President & Ceo
Phone
(573) 600-9613

Specialties & licenses 1

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

Addresses

Primary practice location

154 Forrest Dr
Hannibal, MO 63401-5511

Mailing address

154 Forrest Dr
Hannibal, MO 63401-5511
Phone (573) 221-2120

Other identifiers 1

IdentifierTypeStateIssuer
562473504MedicaidMO

Other names 1

  • Mark Twain Behavioral Health Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140807000426 MO Part B Supplier - Clinic/Group Practice 9436376969 Receives reassigned benefits from 44 practitioners
1 other NPI on this enrollment
Practice locations: Hannibal, MO; Macon, MO; Kirksville, MO

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Mark Twain Area Counsel10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Locations

309 N Missouri St
Macon, MO 63552
Phone (660) 395-9114

Practitioners & affiliated clinicians

Practitioners 46

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 46

NPI Registry JSON

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

{
    "created_epoch": "1167955200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1609804800000",
    "number": "1700933363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "154 FORREST DR",
            "city": "HANNIBAL",
            "state": "MO",
            "postal_code": "634015511",
            "telephone_number": "573-221-2120",
            "fax_number": "573-221-4380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "154 FORREST DR",
            "city": "HANNIBAL",
            "state": "MO",
            "postal_code": "634015511",
            "telephone_number": "573-221-2120",
            "fax_number": "573-221-4380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARK TWAIN ASSOCIATION FOR MENTAL HEALTH, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-05",
        "last_updated": "2021-01-05",
        "certification_date": "2021-01-05",
        "status": "A",
        "authorized_official_last_name": "CANTRELL",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "GENE",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "573-600-9613",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "562473504",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mark Twain Behavioral Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hannibal, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2021; 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.