Organization
DIABETES CLINICARE & WELLNESS SPRINGFIELD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICKY TUCKER (MANAGER)
(417) 413-1351
Entity
Organization
Contact information
Practice address
1649 S ENTERPRISE AVE, SPRINGFIELD, MO 65804-1850
(417) 771-5266
(417) 590-8232
Mailing address
3125 S BRANDYWINE TRL, SPRINGFIELD, MO 65809-4304
(417) 771-5266
(417) 590-8232
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Enumeration date
08/22/2022
Last updated
08/22/2022
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