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General NPI Number Information
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NPI Number | 1457480188
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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 | 03/06/2007
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Last Update Date | 10/14/2025
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Provider Practice Location Address
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Address Line | 120 W 16TH ST
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City | MOUNTAIN GROVE
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State | MO
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Zip | 65711
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Country | US
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Telephone | 417-926-6111
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Fax | 417-926-6115
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Provider Business Mailing Address
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Address Line | 120 W 16TH ST
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City | MOUNTAIN GROVE
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State | MO
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Zip | 65711-1039
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Country | US
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Telephone | 417-820-7133
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | WILLIAM 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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 130675
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 119291
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | R9C21
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License Number State | MO
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Taxonomy #4
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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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