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ST. LOUIS DEVELOPMENTAL DISABILITIES TREATMENT CENTER
NPI 1316991896
General Practice in Saint Charles, MO

Active since May 20, 2006CLIA 26D0881638 · Waiver
22 MARR LN, SAINT CHARLES, MO 63303(314) 340-6702(314) 340-6724 Get Directions Write a Review

NPPES record last updated: October 20, 2020. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Oct 20, 2020, Aug 26, 2019 (2 updates tracked since 2019).

About St. Louis Developmental Disabilities Treatment Center NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ST. LOUIS DEVELOPMENTAL DISABILITIES TREATMENT CENTER (NPI 1316991896) is a healthcare organization registered as a general practice in Saint Charles, Missouri and active in the NPI registry since May 2006. The organization holds a CLIA Waiver certificate valid through January 12, 2028 and lists Molly Jane Boeckmann, Director Of Administrative Services, as its authorized official.

NPPES Registry Identity

NPI1316991896
Entity TypeOrganization
Primary Taxonomy208D00000X
Legal Business NameSTATE OF MISSOURI
Location Address22 MARR LNSaint Charles, MO 63303-9000
Mailing Address1706 E Elm StJefferson City, MO 65101-4130 · (573) 751-3398 · Fax (573) 526-4560
Phone(314) 340-6702
Fax(314) 340-6724
Organization SubpartYes
Authorized OfficialMolly Jane BoeckmannDirector Of Administrative Services · (573) 751-4055
Enumeration DateMay 20, 2006
Last NPPES UpdateOctober 20, 20202 updates tracked since enumeration
NPPES CertifiedOctober 20, 2020
✔ NPI 1316991896 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyGeneral PracticeAllopathic & Osteopathic Physicians
Taxonomy Code208D00000X
Definition
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee
Also ListedPediatricsTaxonomy 208000000X
Also ListedUrologyTaxonomy 208800000X
22 MARR LN, Saint Charles, MO 63303
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Other Names 1

Doing Business AsSt. Louis Developmental Disabilities Treatment Center

Other Identifiers 1

Medicaid501500011MO

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 26D0881638

St Louis Developmental Disabilities Treatment Ctrs · Saint Charles, MO
Active · expires Jan 12, 2028
CLIA Number26D0881638
Laboratory TypeIntermediate Care Facility For Mentally Retarded
Certificate Effective DateJanuary 13, 2026
Certificate Expiration DateJanuary 12, 2028
Laboratory DirectorAmala Kumar Augustine
Laboratory Phone(314) 894-5400
Laboratory LocationSt Louis Developmental Disabilities Treatment Ctrs22 Marr Lane, Saint Charles, MO 63303
CLIA data matches this NPI record on: Address
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KAREN JOYCE FRANKLIN COTA
Occupational Therapy Assistant
22 MARR LN
SAINT CHARLES, MO 63303
St. Charles County (636) 926-1300
AMALAKUMAR D AUGUSTINE MD
Internal Medicine
22 MARR LN
SAINT CHARLES, MO 63303
St. Charles County (636) 926-1316
STATE OF MISSOURI
Intermediate Care Facility, Intellectual Disabilities
22 MARR LN
SAINT CHARLES, MO 63303
St. Charles County (636) 926-1300

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is State Of Missouri's NPI number?

The NPI number for State Of Missouri is 1316991896. It was assigned to this organization in the NPPES registry on May 20, 2006. The provider is doing business as St. Louis Developmental Disabilities Treatment Center.

Where is State Of Missouri located?

State Of Missouri is located at 22 Marr Ln, Saint Charles, MO 63303. The listed phone number is (314) 340-6702.

What is State Of Missouri's specialty?

The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.

Does State Of Missouri hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 26D0881638) is associated with this NPI, valid through January 12, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for State Of Missouri was last updated on October 20, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.