Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

State of Missouri

Organization Pediatrics Physician · NPI 1316991896

State of Missouri is a Pediatrics Physician in Saint Charles, Missouri. Registered with an NPI since 2006.

In the registry since
2006
Specialties on file
3
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Practice location Address checks out

22 Marr Ln
Saint Charles, MO 63303-9000
Phone: (314) 340-6702
Fax: (314) 340-6724
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

General Practice Physician (primary) Taxonomy 208D00000X
Pediatrics Physician Taxonomy 208000000X
Urology Physician Taxonomy 208800000X

Record details

NPI number1316991896
Entity typeOrganization (Type 2)
Organization subpartYes
Parent organizationState of Missouri
Authorized official Molly Boeckmann — Director Of Administrative Services · (573) 751-4055
Other names St. Louis Developmental Disabilities Treatment Center; St. Louis Developmental Disabilities Treatment Center
NPI enumeratedMay 20, 2006
Last updated in NPPESOctober 20, 2020
Certification dateOctober 20, 2020
Mailing address1706 E Elm St, Jefferson City, MO 65101-4130

Other providers in Saint Charles