Mercy Clinic Springfield Communities
Legal Business Name
Mercy Clinic Springfield Communities
NPI Number
1245277631
NPI Type
Organization
Enumeration Date
06/02/2006
Specialties
(Taxonomies)Name
Code
207KA0200X
152WC0802X
207N00000X
207R00000X
156FX1800X
152W00000X
204E00000X
207LP2900X
Primary Taxonomy
No
No
No
No
No
No
No
No
Licenses
State
Missouri
License Number
T002235
Contact
Information
Purpose
Mailing
Location
Address
PO BOX 776071
3231 S NATIONAL AVE STE 220
City
Chicago
Springfield
State
IL
MO
Postal Code
60677-6071
65807
Country
US
US
Telephone Number
(855) 420-7900
(855) 420-7900
Authorized Official
Name
Mr. Stuart Stangeland
Title or Position
CHIEF OPERATING OFFICER
Telephone Number
(417) 820-3873
Identifiers
Identifier
100713130A (GRP. #)
8P045
507679405
CB9013
Identifier State
OK
MO
MO
MO
Identifier Issuer
Unknown
AR BLUE SHIELD GRP #-MO
Unknown
RR MDCR GRP. #
Provider data last refreshed from NPPES NPI registry on 11/19/2024
Data last updated by provider on 05/17/2018