Healthcare Provider Details

I. General information

NPI: 1396931432
Provider Name (Legal Business Name): SPRINGFIELD CLINIC LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2007
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 W WASHINGTON ST
NEWTON IL
62448-1247
US

IV. Provider business mailing address

1025 S 6TH ST PO BOX 19268
SPRINGFIELD IL
62703-2403
US

V. Phone/Fax

Practice location:
  • Phone: 618-783-5094
  • Fax: 618-783-5103
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 StateIL

VIII. Authorized Official

Name: CAL ROBERT THOMAS
Title or Position: CHIEF STRATEGY OFFICER
Credential:
Phone: 217-528-7541