Provider Demographics
NPI:1770616781
Name:MERCY CLINIC SPRINGFIELD COMMUNITIES
Entity type:Organization
Organization Name:MERCY CLINIC SPRINGFIELD COMMUNITIES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-820-7363
Mailing Address - Street 1:608 OLD ROUTE 66
Mailing Address - Street 2:
Mailing Address - City:SAINT ROBERT
Mailing Address - State:MO
Mailing Address - Zip Code:65584-3730
Mailing Address - Country:US
Mailing Address - Phone:573-336-5100
Mailing Address - Fax:
Practice Address - Street 1:608 CITY ROUTE 66
Practice Address - Street 2:
Practice Address - City:ST. ROBERT
Practice Address - State:MO
Practice Address - Zip Code:65584
Practice Address - Country:US
Practice Address - Phone:573-336-5100
Practice Address - Fax:573-336-3118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO095237363LF0000X
MO2003017261207Q00000X
MO261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO593363005Medicaid
MO263813Medicare Oscar/Certification