Healthcare Provider Details

I. General information

NPI: 1811065477
Provider Name (Legal Business Name): MERCY CLINIC SPRINGFIELD COMMUNITIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9138 O'BANION ST
BIRCH TREE MO
65438
US

IV. Provider business mailing address

9138 OBANION ST
BIRCH TREE MO
65438-8485
US

V. Phone/Fax

Practice location:
  • Phone: 573-292-3213
  • Fax: 573-292-4442
Mailing address:
  • Phone: 417-820-7133
  • Fax: 417-820-0586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR7838
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateMO

VIII. Authorized Official

Name: WILLIAM J ROBERTS
Title or Position: CFO
Credential:
Phone: 417-820-7363