Healthcare Provider Details

I. General information

NPI: 1871094052
Provider Name (Legal Business Name): MERCY SOUTHERN MISSOURI AMBULATORY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2018
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E BATTLEFIELD ST STE 124
SPRINGFIELD MO
65807-5208
US

IV. Provider business mailing address

620 S GLENSTONE AVE
SPRINGFIELD MO
65802-3206
US

V. Phone/Fax

Practice location:
  • Phone: 417-556-8967
  • Fax: 417-556-8968
Mailing address:
  • Phone: 417-556-8967
  • Fax: 417-556-8968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JILL MCCART
Title or Position: VP - ACCOUNTING
Credential:
Phone: 314-364-3891