Healthcare Provider Details

I. General information

NPI: 1134251929
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

107 W ELDON ST
SAINT JAMES MO
65559
US

IV. Provider business mailing address

107 W ELDON ST
SAINT JAMES MO
65559-1903
US

V. Phone/Fax

Practice location:
  • Phone: 573-265-1818
  • Fax: 573-265-1810
Mailing address:
  • Phone: 417-820-7133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number36072
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2005030570
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateMO

VIII. Authorized Official

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