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General NPI Number Information
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NPI Number | 1124069877
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Entity Type | Organization
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Legal Business Name | MERCY CLINIC SPRINGFIELD COMMUNITIES
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Dates
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Enumeration Date | 06/10/2006
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Last Update Date | 10/29/2013
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Provider Practice Location Address
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Address Line | 613 ORCHARD DR
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City | BERRYVILLE
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State | AR
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Zip | 72616-5013
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Country | US
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Telephone | 870-423-4240
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Fax | 870-423-4241
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Provider Business Mailing Address
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Address Line | PO BOX 505164
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City | SAINT LOUIS
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State | MO
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Zip | 63150-5164
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Country | US
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Telephone | 417-829-4620
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Fax |
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Authorized Official
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Title or Position | SENIOR VICE PRESIDENT/COO
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Name | MR. STUART G. STANGELAND
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Credential |
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Telephone | 417-820-6556
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | E0693
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | R8E81
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License Number State | AR
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