Organization
MERCY CLINIC SPRINGFIELD COMMUNITIES
Active
Other names
Mercy Clinic Family Medicine Ava
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
1312 NORTH HIGHWAY 5, AVA, MO 65608
(417) 683-4045
(417) 683-6069
Mailing address
PO BOX 505164, SAINT LOUIS, MO 63150-5164
(417) 820-2000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
113969
MO
261QR1300X
Rural Health Clinic/Center
Primary
—
MO
363LF0000X
Family Nurse Practitioner
122348
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
595879701
—
MO
Enumeration date
02/23/2007
Last updated
04/28/2015
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