Provider Demographics
NPI:1710307582
Name:SPRING RIVER MENTAL HEALTH AND WELLNESS INC
Entity Type:Organization
Organization Name:SPRING RIVER MENTAL HEALTH AND WELLNESS INC
Other - Org Name:SPRING RIVER MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-848-2300
Mailing Address - Street 1:PO BOX 550
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:KS
Mailing Address - Zip Code:66770-0550
Mailing Address - Country:US
Mailing Address - Phone:620-848-2380
Mailing Address - Fax:620-848-2381
Practice Address - Street 1:6524 SE QUAKERVALE RD
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:KS
Practice Address - Zip Code:66770-4214
Practice Address - Country:US
Practice Address - Phone:620-848-2380
Practice Address - Fax:620-848-2381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-21
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty