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General NPI Number Information
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NPI Number | 1396871745
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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 | 02/27/2007
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Last Update Date | 04/28/2015
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Provider Practice Location Address
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Address Line | HIGHWAY 19 SOUTH
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City | EMINENCE
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State | MO
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Zip | 65466
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Country | US
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Telephone | 573-226-5401
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Fax | 573-226-3011
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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 | 417-820-2000
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | 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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | R7838
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 112033
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State | MO
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