Provider Demographics
NPI:1942324488
Name:SPRINGFIELD NEPHROLOGY ASSOCIATES INC
Entity Type:Organization
Organization Name:SPRINGFIELD NEPHROLOGY ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:417-886-5000
Mailing Address - Street 1:1911 S NATIONAL AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-2219
Mailing Address - Country:US
Mailing Address - Phone:417-886-5000
Mailing Address - Fax:417-886-1100
Practice Address - Street 1:1911 S NATIONAL AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804
Practice Address - Country:US
Practice Address - Phone:417-886-5000
Practice Address - Fax:417-886-1100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO00422232207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO508269305Medicaid
MO508269305Medicaid