Healthcare Provider Details

I. General information

NPI: 1972823631
Provider Name (Legal Business Name): SPRINGFIELD CLINIC LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2010
Last Update Date: 07/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 DO IT DRIVE
ALTAMONT IL
62411
US

IV. Provider business mailing address

1025 S 6TH ST
SPRINGFIELD IL
62703-2403
US

V. Phone/Fax

Practice location:
  • Phone: 618-483-6131
  • Fax:
Mailing address:
  • Phone: 217-528-7541
  • Fax: 217-528-8962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. ALAN NERONE
Title or Position: CAO
Credential:
Phone: 217-528-7541