Organization
REGIONAL SERVICES
Active
Other names
Pediatric Specialty Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID P TAYLOR (VICE PRESIDENT)
(417) 269-6262
Entity
Organization
Contact information
Practice address
1000 E PRIMROSE ST, #200, SPRINGFIELD, MO 65807-5154
(417) 269-4850
(417) 269-4852
Mailing address
PO BOX 4046, SPRINGFIELD, MO 65808-4046
(417) 269-5712
(417) 269-4869
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
507462802
—
MO
Enumeration date
11/21/2006
Last updated
04/27/2012
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