Provider Demographics
NPI:1629103502
Name:MERCY CLINIC SPRINGFIELD COMMUNITIES
Entity Type:Organization
Organization Name:MERCY CLINIC SPRINGFIELD COMMUNITIES
Other - Org Name:MERCY CLINIC FAMILY MEDICINE-BUFFALO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-820-7363
Mailing Address - Street 1:118 W DALLAS ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:MO
Mailing Address - Zip Code:65622-8669
Mailing Address - Country:US
Mailing Address - Phone:417-820-7133
Mailing Address - Fax:417-820-0586
Practice Address - Street 1:118 W DALLAS ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:MO
Practice Address - Zip Code:65622
Practice Address - Country:US
Practice Address - Phone:417-345-6101
Practice Address - Fax:417-345-6913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO103167207Q00000X
MO261QR1300X
MO076409363LF0000X
MO141415363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO595813908Medicaid
MO263921Medicare Oscar/Certification