Organization
MERCY CLINIC SPRINGFIELD COMMUNITIES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BJ ROBERTS (CFO)
(417) 820-7363
Entity
Organization
Contact information
Practice address
290 CLIFT CT, HOLLISTER, MO 65672-5947
(417) 829-4620
(417) 829-4316
Mailing address
PO BOX 2580, SPRINGFIELD, MO 65801-2580
(417) 829-4620
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
T03477
MO
152WC0802X
Corneal and Contact Management Optometrist
T03477
MO
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
502606502
—
MO
01
—
CB9013
TRAVELERS/RR MEDICARE
MO
Enumeration date
06/04/2006
Last updated
04/30/2025
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