Provider Demographics
NPI:1558997098
Name:CITY UTILITIES OF SPRINGFIELD, MISSOURI
Entity Type:Organization
Organization Name:CITY UTILITIES OF SPRINGFIELD, MISSOURI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TRANSIT GRANTS ANALYST
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRANDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-831-8368
Mailing Address - Street 1:1505 N BOONVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65803-2727
Mailing Address - Country:US
Mailing Address - Phone:417-831-8368
Mailing Address - Fax:417-831-8803
Practice Address - Street 1:1505 N BOONVILLE AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65803-2727
Practice Address - Country:US
Practice Address - Phone:417-831-8368
Practice Address - Fax:417-831-8803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-17
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347B00000XTransportation ServicesBus
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO658692009Medicaid