Provider Demographics
NPI:1255916078
Name:SPRINGFIELD CLINIC LLP
Entity type:Organization
Organization Name:SPRINGFIELD CLINIC LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP, MANAGED CARE & ANCILLARY SERVIC
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:COUSINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-528-7541
Mailing Address - Street 1:PO BOX 19284
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62794-9248
Mailing Address - Country:US
Mailing Address - Phone:217-528-7541
Mailing Address - Fax:
Practice Address - Street 1:1001 MAIN ST STE 300
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61606-2036
Practice Address - Country:US
Practice Address - Phone:309-495-0200
Practice Address - Fax:309-676-6545
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPRINFIELD CLINIC LLP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-03-12
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty