Organization
MERCY CLINIC-SPRINGFIELD COMMUNITIES
Active
Other names
Mercy Clinic Family Medicine-Shell Knob
Organization subpart
No
Provider details
NPI number
Authorized official
STUART G. STANGELAND (SENIOR VICE PRESIDENT, COO)
(417) 820-6556
Entity
Organization
Contact information
Practice address
22361 OAK RIDGE DR, SHELL KNOB, MO 65747-7822
(417) 858-3731
(417) 858-2562
Mailing address
PO BOX 505164, SAINT LOUIS, MO 63150-5164
(417) 820-2000
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1104137876
RURAL HEALTH MEDICAID
MO
Enumeration date
06/28/2010
Last updated
04/28/2015
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