Healthcare Provider Details

I. General information

NPI: 1104137876
Provider Name (Legal Business Name): MERCY CLINIC-SPRINGFIELD COMMUNITIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2010
Last Update Date: 04/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22361 OAK RIDGE DR
SHELL KNOB MO
65747-7822
US

IV. Provider business mailing address

PO BOX 505164
SAINT LOUIS MO
63150-5164
US

V. Phone/Fax

Practice location:
  • Phone: 417-858-3731
  • Fax: 417-858-2562
Mailing address:
  • Phone: 417-820-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateMO

VIII. Authorized Official

Name: STUART G. STANGELAND
Title or Position: SENIOR VICE PRESIDENT, COO
Credential:
Phone: 417-820-6556