OrganizationActiveAccepts Medicare
State of Missouri
NPI 1104878792 · Psychiatric Hospital · Fulton, MO
Enrolled with Medicare as Part a Provider - Hospital · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Provider details
- NPI number
- 1104878792
- Entity type
- Organization
- Primary specialty
- Psychiatric HospitalHospitals
- Parent organization
- State of Missouri
- Organization subpart
- Yes
- Authorized official
- Molly Boeckmann, Director of Administrative Services(573) 751-4055
- License
- EXEMPT (MO)
Specialties & taxonomies
Hospitals
Profile Score
Detailed profile(91/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
20 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
600 E 5th St
Fulton, MO 65251-1753
Phone: (573) 592-4100
Fax: (573) 592-3100
Street-level locationGet directions
Mailing address
Po Box 687
Jefferson City, MO 65102-0687
Other names (DBA / former)
- Doing business as
- Fulton State Hospital
- Doing business as
- Fulton State Hospital
Registry dates
- Enumerated
- 2006-05-16
- Last updated
- 2020-08-31
- Certified
- 2020-08-31
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.