Provider Demographics
NPI:1427002005
Name:SPRINGFIELD NEUROLOGICAL INSTITUTE, L.L.C.
Entity Type:Organization
Organization Name:SPRINGFIELD NEUROLOGICAL INSTITUTE, L.L.C.
Other - Org Name:SPRINGFIELD NEUROLOGICAL INSTITUTE, L.L.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:CRABTREE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:417-885-3888
Mailing Address - Street 1:PO BOX 4024
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65808-4024
Mailing Address - Country:US
Mailing Address - Phone:417-885-3888
Mailing Address - Fax:417-881-7638
Practice Address - Street 1:3801 S NATIONAL AVE STE 700
Practice Address - Street 2:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0201383OtherDEPARTMENT OF LABOR WA
KS141320300OtherDEPARTMENT OF LABOR OWCP
MO502277007Medicaid
AR5C687OtherARKANSAS BC- BS
MO9012802OtherMO DEPT OF HEALTH
AR143549002Medicaid
AR5C687OtherARKANSAS FIRST SOURCE
AR5C687OtherHEALTH ADVANTAGE
MO37110OtherENCOMPASS
MO9012802OtherMO DEPT OF HEALTH
MO=========001OtherHUMANA GOLD CHOICE
MO9012802OtherMO DEPT OF HEALTH
AR5C687Medicare PIN
MO=========001OtherHUMANA GOLD CHOICE
AR143549002Medicaid