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General NPI Number Information
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NPI Number | 1124785779
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Entity Type | Organization
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Legal Business Name | SPRINGFIELD CLINIC LLP
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Dates
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Enumeration Date | 11/18/2021
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Last Update Date | 11/18/2021
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Provider Practice Location Address
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Address Line | 350 W CARPENTER ST
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City | SPRINGFIELD
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State | IL
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Zip | 62702-4902
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Country | US
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Telephone | 217-528-7541
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Fax |
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Provider Business Mailing Address
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Address Line | 1025 S 6TH ST
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City | SPRINGFIELD
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State | IL
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Zip | 62703-2403
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Country | US
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Telephone | 217-528-7541
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | CHRISTOPHER MICHAEL COUSINS
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Credential |
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Telephone | 217-391-7100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State |
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