Healthcare Provider Details

I. General information

NPI: 1972635639
Provider Name (Legal Business Name): MERCY CLINIC SPRINGFIELD COMMUNITIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

904 S PINE ST
RICHLAND MO
65556
US

IV. Provider business mailing address

500 PORTER AVE
AURORA MO
65605-2365
US

V. Phone/Fax

Practice location:
  • Phone: 573-765-2938
  • Fax: 573-765-2938
Mailing address:
  • Phone: 417-820-7133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number115777
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number111554
License Number StateMO
# 3
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