Provider Demographics
NPI:1578338521
Name:ADS SPRINGFIELD WEST LP
Entity Type:Organization
Organization Name:ADS SPRINGFIELD WEST LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KARI
Authorized Official - Middle Name:A
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-501-1082
Mailing Address - Street 1:PO BOX 2933
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65801-2933
Mailing Address - Country:US
Mailing Address - Phone:417-501-1048
Mailing Address - Fax:417-501-1661
Practice Address - Street 1:1701 W SUNSHINE ST STE Q
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-2261
Practice Address - Country:US
Practice Address - Phone:417-501-1048
Practice Address - Fax:417-501-1661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental