Healthcare Provider Details

I. General information

NPI: 1093088593
Provider Name (Legal Business Name): SPRINGFIELD NEUROLOGICAL INSTITUTE, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2012
Last Update Date: 03/29/2023
Certification Date: 03/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3215 N NORTHHILLS BLVD
FAYETTEVILLE AR
72703-4424
US

IV. Provider business mailing address

PO BOX 4024
SPRINGFIELD MO
65808-4024
US

V. Phone/Fax

Practice location:
  • Phone: 417-885-3888
  • Fax:
Mailing address:
  • Phone: 417-885-3888
  • Fax: 417-881-7638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: HERBERT MARK CRABTREE
Title or Position: DIRECTOR/OFFICER
Credential: MD
Phone: 417-885-3888