Fulton State Hospital

LBN: State Of Missouri
Fulton State Hospital is an health care organization with primary practice located at 600 E 5Th St , Fulton MO 65251-1753. The organization recently has 7 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Psychologist, Behavioral Health & Social Service Providers / Clinical, Eye and Vision Services Providers / Optometrist, Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Psychiatry, Podiatric Medicine & Surgery Service Providers / Podiatrist. Allopathic & Osteopathic Physicians / Psychiatry is the primary health care specialty. State Of Missouri can be contacted via phone (573) 592-4100, or through Boeckmann, Molly Jane via phone (573) 751-4055.

Contact Information

Primary practice address
600 E 5Th St Fulton MO 65251-1753
Phone: (573) 592-4100
Fax: (573) 592-3000
Website:
Map and Directions
Authorized official contact:
Name: Boeckmann, Molly Jane
Phone: (573) 751-4055

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Psychologist 103T00000X
Behavioral Health & Social Service Providers / Clinical 103TC0700X
Behavioral Health & Social Service Providers / Clinical 1041C0700X
Eye and Vision Services Providers / Optometrist 152W00000X
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X
Allopathic & Osteopathic Physicians / Psychiatry 2084P0800X
Podiatric Medicine & Surgery Service Providers / Podiatrist 213E00000X

Profile Details

NPI number 1164477873
LBN Legal business name State Of Missouri
DBA Doing business as Fulton State Hospital
Authorized official Boeckmann, Molly Jane
Entity Organization
Organization subpart 1 Yes
Enumeration date May 23rd, 2006
Last updated Aug 28th, 2020 - about 6 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1164477873 NPPES
Missouri MEDICAID 500490008

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