Healthcare Provider Details

I. General information

NPI: 1770434722
Provider Name (Legal Business Name): SPRINGFIELD NEUROLOGICAL AND SPINE INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2026
Last Update Date: 02/05/2026
Certification Date: 02/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 S NATIONAL AVE STE 130
SPRINGFIELD MO
65807-5210
US

IV. Provider business mailing address

1414 E PRIMROSE ST STE 100
SPRINGFIELD MO
65804-4283
US

V. Phone/Fax

Practice location:
  • Phone: 417-885-3888
  • Fax: 417-881-7216
Mailing address:
  • Phone: 417-882-1207
  • Fax: 417-881-7268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number
License Number State

VIII. Authorized Official

Name: BRYAN WILLIAMS
Title or Position: VP OF OPERATIONS
Credential:
Phone: 417-379-3312