Provider Demographics
NPI:1225021231
Name:SPRINGFIELD PHYSICAL MEDICINE AND REHABILITATION, INC
Entity Type:Organization
Organization Name:SPRINGFIELD PHYSICAL MEDICINE AND REHABILITATION, INC
Other - Org Name:SPRINGFIELD PHYSICAL MEDICINE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:C
Authorized Official - Last Name:MAULDIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:417-864-4100
Mailing Address - Street 1:1308 N GLENSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65802-2130
Mailing Address - Country:US
Mailing Address - Phone:417-864-4100
Mailing Address - Fax:417-863-8697
Practice Address - Street 1:1308 N GLENSTONE AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65802-2130
Practice Address - Country:US
Practice Address - Phone:417-864-4100
Practice Address - Fax:417-863-8697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-24
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care