Healthcare Provider Details

I. General information

NPI: 1679264022
Provider Name (Legal Business Name): AMBER ROSE MCCORMICK DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2023
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 S NATIONAL AVE STE 1122
SPRINGFIELD MO
65807-6090
US

IV. Provider business mailing address

3801 S NATIONAL AVE
SPRINGFIELD MO
65807-5210
US

V. Phone/Fax

Practice location:
  • Phone: 141-726-9600
  • Fax:
Mailing address:
  • Phone: 141-726-9600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2026038962
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: