Independent Living Center of Southeast Missouri, Inc.

Primary specialty

Case Management AgencyTaxonomy code 251B00000X

Legal business name

INDEPENDENT LIVING CENTER OF SOUTHEAST MISSOURI, INC.

Practice address

511 Cedar St
Poplar Bluff, MO 63901-7301

Phone

(573) 686-2333

Fax

(573) 686-1641

NPI assigned

Nov 20, 2006

Last updated

Sep 14, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Jennifer Brown

Title

Executive Director

Phone

(573) 686-2333

Specialties & licenses 3

Addresses

Other identifiers 2

Tax ID family

Independent Living Center of Southeast Missouri2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Independent Living Center of Southeast Missouri

  • In Home Supportive Care Agency
  • Poplar Bluff, MO
  • NPI 1295867521
  NPD tax ID

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

{
    "created_epoch": "1163980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631577600000",
    "number": "1720152077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "511 CEDAR ST",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639017301",
            "telephone_number": "573-686-2333",
            "fax_number": "573-686-1641"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "511 CEDAR ST",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639017301",
            "telephone_number": "573-686-2333",
            "fax_number": "573-686-1641"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDEPENDENT LIVING CENTER OF SOUTHEAST MISSOURI, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-20",
        "last_updated": "2021-09-14",
        "certification_date": "2021-09-14",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "573-686-2333",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "MO",
            "license": null,
            "primary": true
        },
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "276211703",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "266211705",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Skye Marie Hutchison
• Kristal Renae Hutson, MSW
• Patrick Hyatt, PHARMD
• Icdoc LLC
• Independent Living Center of Southeast Missouri
• Inman Chiropractic and Rehabilitation Center PLLC
• Joel Matthew Inman, D.C.
• Insightful Behavioral Health
• Integrated Therapy Services LLC
• Integrity Regional Pain Center LLC

• Case Management Agency in Poplar Bluff, MO
• Providers in Poplar Bluff, MO by specialty
• Case Management Agency in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2021; 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.