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General NPI Number Information
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NPI Number | 1366152407
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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 | 11/30/2022
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Last Update Date | 04/30/2025
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Provider Practice Location Address
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Address Line | 1965 S FREMONT AVE STE 200
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City | SPRINGFIELD
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State | MO
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Zip | 65804-2283
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Country | US
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Telephone | 417-820-7233
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 776084
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City | CHICAGO
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State | IL
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Zip | 60677-6084
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | BJ ROBERTS
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Credential |
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Telephone | 417-820-7363
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number |
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License Number State |
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