Provider Demographics
NPI:1700804697
Name:SPRINGFIELD OB-GYN, LLC
Entity Type:Organization
Organization Name:SPRINGFIELD OB-GYN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:HUA-YOA
Authorized Official - Last Name:TING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-882-4466
Mailing Address - Street 1:909 E MONTCLAIR ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-5068
Mailing Address - Country:US
Mailing Address - Phone:417-882-4466
Mailing Address - Fax:417-890-5631
Practice Address - Street 1:909 E MONTCLAIR ST
Practice Address - Street 2:SUITE 120
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5068
Practice Address - Country:US
Practice Address - Phone:417-882-4466
Practice Address - Fax:417-890-5631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO113753207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOG59079Medicare UPIN