# DIABETES CLINICARE & WELLNESS SPRINGFIELD LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1548988835
- **Authorized official:** RICKY TUCKER (MANAGER)
- **Authorized official phone:** (417) 413-1351

## Contact information

- **Practice address:** 1649 S ENTERPRISE AVE, SPRINGFIELD, MO 65804-1850
- **Practice address phone:** (417) 771-5266
- **Practice address fax:** (417) 590-8232
- **Mailing address:** 3125 S BRANDYWINE TRL, SPRINGFIELD, MO 65809-4304
- **Mailing address phone:** (417) 771-5266
- **Mailing address fax:** (417) 590-8232

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | — | NULL | — |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | — | — | — |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 08/22/2022
- **Last updated:** 08/22/2022