Healthcare Provider Details

I. General information

NPI: 1649477456
Provider Name (Legal Business Name): MERCY CLINIC-SPRINGFIELD COMMUNITIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 09/02/2025
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 HOSPITAL DR SUITE E
LEBANON MO
65536-9217
US

IV. Provider business mailing address

341 HOSPITAL DR
LEBANON MO
65536-9217
US

V. Phone/Fax

Practice location:
  • Phone: 417-533-7540
  • Fax: 417-533-6550
Mailing address:
  • Phone: 417-533-6540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number106044
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number StateMO

VIII. Authorized Official

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