Healthcare Provider Details

I. General information

NPI: 1811028186
Provider Name (Legal Business Name): SPRINGFIELD EAR NOSE THROAT & FACIAL PLASTIC SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 04/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 S CULPEPPER CIR
SPRINGFIELD MO
65804-4222
US

IV. Provider business mailing address

3555 S CULPEPPER CIR
SPRINGFIELD MO
65804-4222
US

V. Phone/Fax

Practice location:
  • Phone: 417-887-3855
  • Fax: 417-887-3857
Mailing address:
  • Phone: 417-887-3855
  • Fax: 417-887-3857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number2000172900
License Number StateMO

VIII. Authorized Official

Name: MRS. SHAWNEA ADAMS
Title or Position: ACCOUNTS MANAGER
Credential:
Phone: 417-887-3855