| Fulton State Hospital | |
|
600 E 5th St Fulton MO 65251-1753 | |
| (573) 592-4100 | |
| (573) 592-3000 |
| Full Name | Fulton State Hospital |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 600 E 5th St, Fulton, Missouri |
| Authorized Official Name and Position | Molly Jane Boeckmann (DIRECTOR OF ADMINISTRATIVE SERVICES) |
| Authorized Official Contact | 5737514055 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fulton State Hospital 1706 E Elm St Po Box 687 Jefferson City MO 65101-4130 Ph: (573) 751-3398 | Fulton State Hospital 600 E 5th St Fulton MO 65251-1753 Ph: (573) 592-4100 |
| NPI Number | 1164477873 |
|---|---|
| Provider Enumeration Date | 05/23/2006 |
| Last Update Date | 08/28/2020 |
| Certification Date | 08/28/2020 |
| Medicare PECOS PAC ID | 1456254226 |
|---|---|
| Medicare Enrollment ID | O20040129000481 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164477873 | NPI | - | NPPES |
| 500490008 | Medicaid | MO |
| Provider Name | Robert B Sexe |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1124121363 PECOS PAC ID: 9032100458 Enrollment ID: I20040524000170 |
| Provider Name | Sanjv Sethi |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1942225073 PECOS PAC ID: 2961467790 Enrollment ID: I20041122000396 |
| Provider Name | Andrew G Resnik |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1346299682 PECOS PAC ID: 0941259253 Enrollment ID: I20050113000563 |
| Provider Name | Colleen Loehr |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1073689337 PECOS PAC ID: 8123047966 Enrollment ID: I20051122000201 |
| Provider Name | Richard P Doisy |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1255341491 PECOS PAC ID: 8123113800 Enrollment ID: I20070927000067 |
| Provider Name | Tina M Drury |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1326107236 PECOS PAC ID: 4183706542 Enrollment ID: I20080124000534 |
| Provider Name | Sharon B Robbins |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1124201603 PECOS PAC ID: 9739262999 Enrollment ID: I20080211000630 |
| Provider Name | Anthony Menditto |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1376729616 PECOS PAC ID: 3375628993 Enrollment ID: I20080306000575 |
| Provider Name | Amy A Fleming |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1285781781 PECOS PAC ID: 3779650569 Enrollment ID: I20080919000475 |
| Provider Name | Ahsan Syed |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1003970849 PECOS PAC ID: 5890854681 Enrollment ID: I20081107000744 |
| Provider Name | Lee Ann Mcvay |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1417272287 PECOS PAC ID: 5698806503 Enrollment ID: I20100621000749 |
| Provider Name | Miles C Reece |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1457486870 PECOS PAC ID: 1658548391 Enrollment ID: I20120119000862 |
| Provider Name | Lindsey Schrimpf |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1912162967 PECOS PAC ID: 1052582947 Enrollment ID: I20120210000335 |
| Provider Name | Jairam Das |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1164686176 PECOS PAC ID: 4880840354 Enrollment ID: I20120816000307 |
| Provider Name | Robert William Johnson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1699030510 PECOS PAC ID: 4688823123 Enrollment ID: I20120927000336 |
| Provider Name | Justin D Terrell |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1689986275 PECOS PAC ID: 6507007895 Enrollment ID: I20130730000160 |
| Provider Name | Naveen Yarasi |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1689804262 PECOS PAC ID: 4183867013 Enrollment ID: I20130826000315 |
| Provider Name | Osamede Edokpolo |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1326334459 PECOS PAC ID: 2062655723 Enrollment ID: I20130827000958 |
| Provider Name | Nirmala Kurian |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1184783003 PECOS PAC ID: 5890916779 Enrollment ID: I20141017000280 |
| Provider Name | Alicia Loraine Pardee |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1528424256 PECOS PAC ID: 2365745544 Enrollment ID: I20160121001503 |
| Provider Name | Grace Gombe Munthali |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770949406 PECOS PAC ID: 0345547188 Enrollment ID: I20160323000187 |
| Provider Name | Jessica Ann Peterson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1578014726 PECOS PAC ID: 4082994553 Enrollment ID: I20161130000425 |
| Provider Name | Mohammad Yousuf |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1942571476 PECOS PAC ID: 9234411943 Enrollment ID: I20170112001889 |
| Provider Name | Andrew White |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194261370 PECOS PAC ID: 2365724150 Enrollment ID: I20170201000459 |
| Provider Name | Swarnalatha Yerrapu |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1366720385 PECOS PAC ID: 9335424977 Enrollment ID: I20170323000202 |
| Provider Name | Amanda Kingston |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1770924771 PECOS PAC ID: 8527334762 Enrollment ID: I20171016003173 |
| Provider Name | Narayana Rao Adusumilli |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1891706115 PECOS PAC ID: 1052663838 Enrollment ID: I20181004002951 |
| Provider Name | Kevin Joseph Carpenter |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1134664857 PECOS PAC ID: 7214369834 Enrollment ID: I20191119002284 |
| Provider Name | Rebekah Antoinette Purvis |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1487179602 PECOS PAC ID: 3678908647 Enrollment ID: I20200122000092 |
| Provider Name | Alexis Calliope Nicole Reddig |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1982240438 PECOS PAC ID: 0143655159 Enrollment ID: I20200122001217 |
| Provider Name | Steven Michael Edwards |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1346872306 PECOS PAC ID: 9234566878 Enrollment ID: I20200220002699 |
| Provider Name | Jacqueline Suzette Maragh-lawrence |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801411301 PECOS PAC ID: 6608298815 Enrollment ID: I20200617000100 |
| Provider Name | Barbara Borde-koufie |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851916944 PECOS PAC ID: 5890117980 Enrollment ID: I20200618000700 |
| Provider Name | Omagbemi Buwa |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1922597871 PECOS PAC ID: 3678828928 Enrollment ID: I20210825001615 |
| Provider Name | Charles Eli Welch |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1316443856 PECOS PAC ID: 1052646536 Enrollment ID: I20210930001767 |
| Provider Name | David B Mauro |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1558855858 PECOS PAC ID: 2264788918 Enrollment ID: I20211101000605 |
| Provider Name | Joshua W Foster |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1700447190 PECOS PAC ID: 4284969973 Enrollment ID: I20211210000752 |
| Provider Name | Joel Saeger |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1306405717 PECOS PAC ID: 3971837816 Enrollment ID: I20211213000412 |
| Provider Name | Vera I Prisacari |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1982196564 PECOS PAC ID: 5890040638 Enrollment ID: I20211214002682 |
| Provider Name | Elizabeth A Bryant |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1295225043 PECOS PAC ID: 5799176137 Enrollment ID: I20211220001794 |
| Provider Name | Matthew C Stull |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1770299265 PECOS PAC ID: 7315319969 Enrollment ID: I20230208002828 |
| Provider Name | Dale Switzer |
|---|---|
| Provider Type | Practitioner - Osteopathic Manipulative Medicine |
| Provider Identifiers | NPI Number: 1861855587 PECOS PAC ID: 5698008282 Enrollment ID: I20230211000468 |
| Provider Name | Amy Lewis |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1275249153 PECOS PAC ID: 8820460967 Enrollment ID: I20230217001680 |
| Provider Name | Evan M Buckmiller |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1396361853 PECOS PAC ID: 6709200025 Enrollment ID: I20230411002746 |
| Provider Name | Kalee Drue Woody |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1508432378 PECOS PAC ID: 5698174142 Enrollment ID: I20230414001933 |
| Provider Name | Tamar Maragh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356128318 PECOS PAC ID: 8921462334 Enrollment ID: I20230918002356 |
| Provider Name | Audra Biermann |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1881469864 PECOS PAC ID: 9739538232 Enrollment ID: I20231208002782 |
| Provider Name | David Robert Hunter |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1821009135 PECOS PAC ID: 8426407412 Enrollment ID: I20231215002770 |
Refound Psychiatry Services Llc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 10 S Hospital Dr, Fulton, MO 65251 Phone: 573-443-4431 | |
Brighter Day Counseling Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1 University Ave, Fulton, MO 65251 Phone: 248-219-7491 | |
Brighter Day Health Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 473 Law Ct, Fulton, MO 65251 Phone: 713-581-8801 Fax: 713-481-0240 | |
Arthur Center Behavioral Health Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 581 Commons Drive, Fulton, MO 65251 Phone: 573-642-3215 Fax: 573-581-1981 | |
Susan Langstraat Lcsw Llc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 2151 County Road 228, Fulton, MO 65251 Phone: 573-999-6207 | |
Callaway Community Hospital Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 10 S Hospital Dr, Fulton, MO 65251 Phone: 573-642-3376 Fax: 573-592-6679 |