Provider Demographics
NPI:1790814465
Name:SPRINGFIELD NEUROLOGICAL INSTITUTE, L.L.C.
Entity Type:Organization
Organization Name:SPRINGFIELD NEUROLOGICAL INSTITUTE, L.L.C.
Other - Org Name:SNI IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:CRABTREE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:417-885-3888
Mailing Address - Street 1:PO BOX 4024
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65808-4024
Mailing Address - Country:US
Mailing Address - Phone:417-885-3888
Mailing Address - Fax:417-881-7638
Practice Address - Street 1:2900 S NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-3634
Practice Address - Country:US
Practice Address - Phone:417-885-3888
Practice Address - Fax:417-881-7638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiologyGroup - Multi-Specialty
No207RM1200XAllopathic & Osteopathic PhysiciansInternal MedicineMagnetic Resonance Imaging (MRI)Group - Multi-Specialty
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Multi-Specialty
No2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric RadiologyGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS141320300OtherDEPARTMENT OF LABOR OWCP
AR143549002Medicaid
AR5C687OtherHEALTH ADVANTAGE
MO37110OtherENCOMPAS
MO502277007OtherGTE VERISON DATA SERVICES
AR5C687OtherARKANSAS BC/BS
AR143549002Medicaid
AR143549002Medicaid
AR5C687OtherHEALTH ADVANTAGE
MO502277007OtherGTE VERISON DATA SERVICES
AR5C687Medicare PIN