Healthcare Provider Details

I. General information

NPI: 1477756609
Provider Name (Legal Business Name): MERCY HOSPITAL SPRINGFIELD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 12/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SPARKY STREET
GREEN FOREST AR
72638-2713
US

IV. Provider business mailing address

1235 E CHEROKEE ST
SPRINGFIELD MO
65804-2203
US

V. Phone/Fax

Practice location:
  • Phone: 870-438-5718
  • Fax:
Mailing address:
  • Phone: 417-820-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number125
License Number StateAR

VIII. Authorized Official

Name: MR. SCOTT R REYNOLDS
Title or Position: VICE PRESIDENT - FINANCE
Credential:
Phone: 417-820-2818