MEDICARE: DR. CHARLES C MAULDIN JR. M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	MDR6J28	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	43151887165802A005	OTHER	MO	TRIWEST
3	ACS#140740000	OTHER	MO	US POSTAL SERVICE
4	2079425	OTHER	MO	FIRST HEALTH
5	19288	OTHER	MO	BLUE CROSS/BLUE SHIELD
6	26D1025378	OTHER	MO	CLIA
7	9378408	OTHER	MO	PHCS

General Provider Information

NPI Number	:	1194718270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES C MAULDIN JR. M.D.

Provider Business Mailing Address
First Line	:	5015 S GLENHAVEN AVE
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65804-7800
Country	:	US
Telephone Number	:	417-881-7808
Fax Number	:

Provider Business Practice Location Address
First Line	:	1308 N GLENSTONE AVE
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65802-2130
Country	:	US
Telephone Number	:	417-864-4100
Fax Number	:	417-863-8697

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	09/27/2007

Similar Medicare Providers

1467527317 — DR. MICHAEL B HALLE MD
Practice Location Address:

2101 E JEFFERSON ST , KAISER PERMANENTE SPRINGFIELD MEDICARE ENROLLMENT
ROCKVILLE, MD
20852-4908

Practice Phone: 701-922-1000
Practice Fax: 703-922-1039

1225021231 — SPRINGFIELD PHYSICAL MEDICINE AND REHABILITATION, INC
Practice Location Address:

1308 N GLENSTONE AVE
SPRINGFIELD, MO
65802-2130

Practice Phone: 417-864-4100
Practice Fax: 417-863-8697

1619053287 — DR. GILBERT LOUIS MOBLEY MD
Practice Location Address:

1308 N GLENSTONE AVE
SPRINGFIELD, MO
65802-2130

Practice Phone: 417-864-4100
Practice Fax: 417-863-8697

1972786119 — AMERICAN CURRENT CARE PA
Practice Location Address:

1308 N. GLENSTONE AVENUE
SPRINGFIELD, MO
65802-2130

Practice Phone: 417-864-4100
Practice Fax: 417-863-0384

1063663144 — MS. KAYLA RENEE BROWN COTA/L
Practice Location Address:

1308 N GLENSTONE AVE
SPRINGFIELD, MO
65802-2130

Practice Phone: 417-864-4100
Practice Fax: 417-863-8697

1184971863 — CHELSEA D STRAUB DPT
Practice Location Address:

1308 N GLENSTONE AVE
SPRINGFIELD, MO
65802-2130

Practice Phone: 417-864-4100
Practice Fax:

Directions to “ DR. CHARLES C MAULDIN JR. M.D.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.