Healthcare Provider Details

I. General information

NPI: 1760936264
Provider Name (Legal Business Name): MERCY CLINIC SPRINGFIELD COMMUNITIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2016
Last Update Date: 12/11/2023
Certification Date: 12/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 N 25TH ST
OZARK MO
65721-9069
US

IV. Provider business mailing address

505 N 25TH ST
OZARK MO
65721-9069
US

V. Phone/Fax

Practice location:
  • Phone: 417-820-9393
  • Fax: 417-731-3393
Mailing address:
  • Phone: 417-731-3395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2016020876
License Number StateMO

VIII. Authorized Official

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