Healthcare Provider Details

I. General information

NPI: 1659785657
Provider Name (Legal Business Name): MERCY CLINIC SPRINGFIELD COMMUNITIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2014
Last Update Date: 06/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11701 BEE CAVE PKWY SUITE 213
BEE CAVE TX
78738-6466
US

IV. Provider business mailing address

PO BOX 505164
SAINT LOUIS MO
63150-5164
US

V. Phone/Fax

Practice location:
  • Phone: 417-820-9219
  • Fax:
Mailing address:
  • Phone: 417-829-4620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number StateTX

VIII. Authorized Official

Name: STUART G. STANGELAND
Title or Position: SENIOR VICE PRESIDENT/COO
Credential:
Phone: 417-820-6556