MEDICARE: MERCY CLINIC-SPRINGFIELD COMMUNITIES

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	207Q00000X	Family Medicine Physician	2005013261	MO
2	363LF0000X	Family Nurse Practitioner	130675	MO
3	363LF0000X	Family Nurse Practitioner	119291	MO
4	261QR1300X	Rural Health Clinic/Center		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

General Provider Information

NPI Number	:	1487783296
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERCY CLINIC-SPRINGFIELD COMMUNITIES

Provider Business Mailing Address
First Line	:	645 MARYVILLE CENTRE DR FL 3
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-5855
Country	:	US
Telephone Number	:	417-820-7133
Fax Number	:	417-820-0586

Provider Business Practice Location Address
First Line	:	1422 S SAM HOUSTON BLVD
Second Line	:
City	:	HOUSTON
State	:	MO
Zip	:	65483
Country	:	US
Telephone Number	:	417-967-4445
Fax Number	:	417-967-4453

Authorized Official
Title or Position	:	SENIOR VICE PRESIDENT/COO
Name	:	STUART G. STANGELAND
Credential	:
Telephone Number	:	417-820-3873

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	06/12/2018

Similar Medicare Providers

1568463925 — DAVID W DALE D.O.
Practice Location Address:

1340 S SAM HOUSTON BLVD
HOUSTON, MO
65483-2045

Practice Phone: 417-967-3755
Practice Fax: 417-967-2630

1902892847 — GLEN C MARSEY LCSW
Practice Location Address:

1340 S SAM HOUSTON BLVD
HOUSTON, MO
65483-2045

Practice Phone: 417-967-3755
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1699763383 — STEVEN CHARLES HUTCHESON PHARMACIST
Practice Location Address:

1330 SOUTH HIGHWAY 63
HOUSTON, MO
65483

Practice Phone: 417-967-4139
Practice Fax: 417-967-4130

1356324727 — TEXAS COUNTY MEMORIAL HOSPITAL
Practice Location Address:

1422 S SAM HOUSTON BLVD STE 200
HOUSTON, MO
65483

Practice Phone: 417-967-1240
Practice Fax: 417-967-2360

1962473975 — DR. HOLLIS TIDMORE MD
Practice Location Address:

1422 S SAM HOUSTON BLVD
HOUSTON, MO
65483-2130

Practice Phone: 417-967-1252
Practice Fax: 417-967-0417

1093780678 — TEXAS COUNTY MEMORIAL HOSPITAL
Practice Location Address:

1422 S SAM HOUSTON BLVD STE 300
HOUSTON, MO
65483-2119

Practice Phone: 417-967-1279
Practice Fax: 417-967-1335

1164483921 — DR. CHRISTOPHER O BALDWIN M.D.
Practice Location Address:

1337 S SAM HOUSTON BLVD
HOUSTON, MO
65483

Practice Phone: 417-967-5639
Practice Fax: 417-967-5667

Directions to “MERCY CLINIC-SPRINGFIELD COMMUNITIES ” Practice Location

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