Provider Demographics
NPI:1598841140
Name:MRI OF SPRINGFIELD, INC
Entity Type:Organization
Organization Name:MRI OF SPRINGFIELD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:E
Authorized Official - Last Name:BOOTS
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:573-315-9109
Mailing Address - Street 1:1420 E BRADFORD PKWY
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-6563
Mailing Address - Country:US
Mailing Address - Phone:417-885-1100
Mailing Address - Fax:417-885-1109
Practice Address - Street 1:1420 E BRADFORD PKWY
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-6563
Practice Address - Country:US
Practice Address - Phone:417-885-1100
Practice Address - Fax:417-885-1109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO714637501Medicaid
MO000093006Medicare ID - Type Unspecified