Healthcare Provider Details

I. General information

NPI: 1003980293
Provider Name (Legal Business Name): SURGERY CENTER OF SPRINGFIELD ANESTHESIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 E WOODHURST DR
SPRINGFIELD MO
65804-4281
US

IV. Provider business mailing address

1350 E WOODHURST DR
SPRINGFIELD MO
65804-4281
US

V. Phone/Fax

Practice location:
  • Phone: 417-887-5243
  • Fax: 417-887-6507
Mailing address:
  • Phone: 417-887-5243
  • Fax: 417-887-6507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number49-15
License Number StateMO

VIII. Authorized Official

Name: MRS. REBECCA WILLIAMS
Title or Position: INSURANCE SPECIALIST
Credential:
Phone: 417-887-5243