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

State of Missouri

Organization Family Medicine Physician · NPI 1710931167

State of Missouri is a Family Medicine Physician in Saint Louis, 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

10695 Bellefontaine Rd
Saint Louis, MO 63137-2315
Phone: (314) 340-6000
Fax: (314) 340-6199
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Medicine & Rehabilitation Physician (primary) Taxonomy 208100000X
Family Medicine Physician Taxonomy 207Q00000X
Psychiatry Physician Taxonomy 2084P0800X

Record details

NPI number1710931167
Entity typeOrganization (Type 2)
Organization subpartYes
Parent organizationState of Missouri
Authorized official Molly Boeckmann — Director Of Administrative Services · (573) 751-4055
Other names Bellefontaine Habilitation Center; Bellefontaine Habilitation Center
NPI enumeratedMay 20, 2006
Last updated in NPPESOctober 27, 2020
Certification dateOctober 27, 2020
Mailing address1706 E Elm St, Jefferson City, MO 65101-4130

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