Healthcare Provider Details

I. General information

NPI: 1326019902
Provider Name (Legal Business Name): NORTH SPRINGFIELD FAMILY MEDICAL WALK IN CLINICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 08/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2619 N KANSAS EXPY
SPRINGFIELD MO
65803-1114
US

IV. Provider business mailing address

4049 S CAMPBELL AVE
SPRINGFIELD MO
65807-5303
US

V. Phone/Fax

Practice location:
  • Phone: 417-866-5550
  • Fax: 417-866-6213
Mailing address:
  • Phone: 417-890-5550
  • Fax: 417-889-6898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberR5B57
License Number StateMO

VIII. Authorized Official

Name: DR. DANIEL J BURKE
Title or Position: OWNER/MEDICAL DIRECTOR
Credential: D.O.
Phone: 417-890-5550