1538325931 NPI number — MERCY CLINIC SPRINGFIELD COMMUNITIES

Table of content: (NPI 1538325931)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538325931 NPI number — MERCY CLINIC SPRINGFIELD COMMUNITIES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERCY CLINIC SPRINGFIELD COMMUNITIES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SJC-NEUROSURGERY-ROGERS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538325931
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/27/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2580
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65801-2580
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-829-4620
Provider Business Mailing Address Fax Number:
417-829-4316

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2708 RIFE MEDICAL LN
Provider Second Line Business Practice Location Address:
SUITE 310
Provider Business Practice Location Address City Name:
ROGERS
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72758-1452
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-338-3270
Provider Business Practice Location Address Fax Number:
479-338-3287
Provider Enumeration Date:
08/05/2008

Additional Information

Authorized Official

Authorized Official Last Name:
STANGELAND
Authorized Official First Name:
STUART
Authorized Official Middle Name:
G.
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
417-820-3514

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X , with the licence number:  E5600 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363A00000X , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PENDING . This is a "AR MEDICAID" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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