Healthcare Provider Details

I. General information

NPI: 1669763116
Provider Name (Legal Business Name): REGIONAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2011
Last Update Date: 05/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 N. KANSAS EXPRESSWAY
SPRINGFIELD MO
65803-1017
US

IV. Provider business mailing address

PO BOX 4046
SPRINGFIELD MO
65808-4046
US

V. Phone/Fax

Practice location:
  • Phone: 417-868-7026
  • Fax: 417-868-7033
Mailing address:
  • Phone: 417-269-5712
  • Fax: 417-269-4869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DAVID P. TAYLOR
Title or Position: VICE PRESIDENT
Credential:
Phone: 417-269-4320