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General NPI Number Information
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NPI Number | 1003980293
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Entity Type | Organization
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Legal Business Name | SURGERY CENTER OF SPRINGFIELD ANESTHESIA
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1350 E WOODHURST DR
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City | SPRINGFIELD
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State | MO
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Zip | 65804-4281
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Country | US
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Telephone | 417-887-5243
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Fax | 417-887-6507
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Provider Business Mailing Address
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Address Line | 1350 E WOODHURST DR
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City | SPRINGFIELD
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State | MO
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Zip | 65804-4281
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Country | US
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Telephone | 417-887-5243
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Fax | 417-887-6507
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Authorized Official
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Title or Position | INSURANCE SPECIALIST
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Name | MRS. REBECCA WILLIAMS
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Credential |
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Telephone | 417-887-5243
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 49-15
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License Number State | MO
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