Healthcare Provider Details

I. General information

NPI: 1598841140
Provider Name (Legal Business Name): MRI OF SPRINGFIELD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 E BRADFORD PKWY
SPRINGFIELD MO
65804-6563
US

IV. Provider business mailing address

1420 E BRADFORD PKWY
SPRINGFIELD MO
65804-6563
US

V. Phone/Fax

Practice location:
  • Phone: 417-885-1100
  • Fax: 417-885-1109
Mailing address:
  • Phone: 417-885-1100
  • Fax: 417-885-1109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number StateMO

VIII. Authorized Official

Name: MR. HENRY E BOOTS II
Title or Position: VP
Credential:
Phone: 573-315-9109