Organization
STATE OF MISSOURI
Active
Parent organization
STATE OF MISSOURI
Other names
NWCS-Optimistic Beginnings
Organization subpart
Yes
Provider details
NPI number
Legal business name
STATE OF MISSOURI
Authorized official
MOLLY JANE BOECKMANN (DIRECTOR OF ADMINISTRATIVE SERVICES)
(573) 751-4055
Entity
Organization
Contact information
Practice address
1547 W COMMERCE DRIVE, MARSHALL, MO 65340-3907
(660) 886-2201
(660) 886-3055
Mailing address
PO BOX 190, MARSHALL, MO 65340-0190
(660) 886-2201
(660) 886-3055
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
02/24/2017
Last updated
10/15/2020
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