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General NPI Number Information
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NPI Number | 1962534727
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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 | 03/09/2007
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Last Update Date | 06/11/2018
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Provider Practice Location Address
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Address Line | 332 S MAIN AVE
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City | REPUBLIC
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State | MO
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Zip | 65738
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Country | US
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Telephone | 417-732-5050
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Fax | 417-732-8061
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Provider Business Mailing Address
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Address Line | 645 MARYVILLE CENTRE DR FL 3
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City | SAINT LOUIS
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State | MO
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Zip | 63141-5855
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Country | US
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Telephone | 417-820-7133
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Fax | 417-820-0586
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Authorized Official
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Title or Position | SENIOR VICE PRESIDENT
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Name | STUART STANGELAND
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Credential |
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Telephone | 417-820-3873
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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 | 107047
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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 | 2001029957
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 145564
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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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