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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
3231 S NATIONAL AVE STE 220, SPRINGFIELD, MO 65807
(855) 420-7900
(417) 829-4316
Mailing address
PO BOX 776071, CHICAGO, IL 60677-6071
(855) 420-7900
(417) 829-4316

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
T002235
MO
152W00000X
Optometrist
MO
152WC0802X
Corneal and Contact Management Optometrist
T002235
MO
156FX1800X
Optician
MO
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
207KA0200X
Allergy Physician
207LP2900X
Pain Medicine (Anesthesiology) Physician
207N00000X
Dermatology Physician
207Q00000X
Family Medicine Physician
Primary
MO
207R00000X
Internal Medicine Physician
MO
207RH0003X
Hematology & Oncology Physician
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100713130A (GRP. #)
OK
05
507679405
MO
01
8P045
AR BLUE SHIELD GRP #-MO
MO
01
CB9013
RR MDCR GRP. #
MO
Enumeration date
06/02/2006
Last updated
04/30/2025
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