Provider Demographics
NPI:1053508960
Name:SPRINGFIELD CLINIC LLP
Entity Type:Organization
Organization Name:SPRINGFIELD CLINIC LLP
Other - Org Name:SPRINGFIELD CLINIC RURAL HEALTH FLORA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VICE PRESIDENT & CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NERONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-528-7541
Mailing Address - Street 1:1025 S 6TH ST
Mailing Address - Street 2:PO BOX 19248
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62703-2403
Mailing Address - Country:US
Mailing Address - Phone:217-528-7541
Mailing Address - Fax:217-528-8962
Practice Address - Street 1:501 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FLORA
Practice Address - State:IL
Practice Address - Zip Code:62839-1405
Practice Address - Country:US
Practice Address - Phone:618-403-5040
Practice Address - Fax:618-403-5042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2017-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILPENDINGOtherMEDICARE PART A #
ILPENDINGOtherMEDICARE PART A #