Provider Demographics
NPI:1114971264
Name:MACE, JOHN CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:CHARLES
Last Name:MACE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9434
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65801-9434
Mailing Address - Country:US
Mailing Address - Phone:417-885-3888
Mailing Address - Fax:417-881-7638
Practice Address - Street 1:3801 S NATIONAL AVE
Practice Address - Street 2:WEST TOWER, SUITE 700
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5210
Practice Address - Country:US
Practice Address - Phone:417-885-3888
Practice Address - Fax:417-881-7638
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE3602207T00000X
MO118061207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5M988OtherARKANSAS BC/BS
MO18942OtherCOX HEALTH PLANS
MO203985700Medicaid
AR5M988OtherHEALTH ADVANTAGE
MO04040017000OtherQUAL CHOICE
WA0215049OtherDEPARTMENT OF LABOR WA
MO119340OtherBLUE CROSS/CHOICE
MO0156395001OtherCIGNA HEALTHCARE
AR139629001Medicaid
MO4188130001OtherCIGNA MEDICARE
MO0602002OtherUNITED HEALTHCARE
MO412307OtherHEALTHLINK
AR5M988OtherARKANSAS FIRST SOURCE
MOG93208OtherUSPS (W/C)
MO7623OtherCOX HEALTH PLANS UPI
MO4188130001OtherCIGNA MEDICARE
AR5M988OtherARKANSAS FIRST SOURCE
MO0156395001OtherCIGNA HEALTHCARE
MO119340OtherBLUE CROSS/CHOICE
MO18942OtherCOX HEALTH PLANS
MOG93208OtherUSPS (W/C)
MO203985700Medicaid
AR5M988Medicare PIN
MO004013401Medicare PIN