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General NPI Number Information
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NPI Number | 1174693709
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Entity Type | Organization
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Legal Business Name | REGIONAL SERVICES
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Dates
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Enumeration Date | 11/09/2006
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Last Update Date | 03/14/2017
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Provider Practice Location Address
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Address Line | 3525 S NATIONAL AVE #101
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City | SPRINGFIELD
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State | MO
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Zip | 65807-7310
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Country | US
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Telephone | 417-269-9950
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Fax | 417-269-9959
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Provider Business Mailing Address
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Address Line | PO BOX 4046
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City | SPRINGFIELD
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State | MO
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Zip | 65808-4046
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Country | US
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Telephone | 417-269-5712
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Fax | 417-269-7567
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MAX BUETOW
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Credential |
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Telephone | 417-631-0381
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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