Healthcare Provider Details

I. General information

NPI: 1619173846
Provider Name (Legal Business Name): MERCY CLINIC-SPRINGFIELD COMMUNITIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 W MOUNT VERNON ST SUITE 120
NIXA MO
65714-9609
US

IV. Provider business mailing address

940 W MOUNT VERNON ST STE 120
NIXA MO
65714-9614
US

V. Phone/Fax

Practice location:
  • Phone: 417-724-5335
  • Fax: 417-724-5333
Mailing address:
  • Phone: 417-724-5335
  • Fax: 417-725-5333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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