Healthcare Provider Details

I. General information

NPI: 1053444000
Provider Name (Legal Business Name): MERCY CLINIC SPRINGFIELD COMMUNITIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 07/21/2023
Certification Date: 07/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 ROGERS AVE
SUMMERSVILLE MO
65571
US

IV. Provider business mailing address

149 ROGERS AVE
SUMMERSVILLE MO
65571
US

V. Phone/Fax

Practice location:
  • Phone: 417-932-4119
  • Fax: 417-932-4838
Mailing address:
  • Phone: 417-820-7133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR7838
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateMO

VIII. Authorized Official

Name: WILLIAM ROBERTS
Title or Position: CFO
Credential:
Phone: 417-820-7363