Healthcare Provider Details

I. General information

NPI: 1023188562
Provider Name (Legal Business Name): REGIONAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

816 E MAIN ST
WILLOW SPRINGS MO
65793-1518
US

IV. Provider business mailing address

PO BOX 4046
SPRINGFIELD MO
65808-4046
US

V. Phone/Fax

Practice location:
  • Phone: 417-469-3116
  • Fax: 417-469-3151
Mailing address:
  • Phone: 417-269-7834
  • Fax: 417-269-7567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAVID P TAYLOR
Title or Position: VICE PRESIDENT
Credential:
Phone: 417-269-6262