Organization
MERCY CLINIC SPRINGFIELD COMMUNITIES
Active
Other names
Mercy Clinic Family Medicine-Republic
Organization subpart
No
Provider details
NPI number
Authorized official
STUART STANGELAND (SENIOR VICE PRESIDENT)
(417) 820-3873
Entity
Organization
Contact information
Practice address
332 S MAIN AVE, REPUBLIC, MO 65738
(417) 732-5050
(417) 732-8061
Mailing address
645 MARYVILLE CENTRE DR FL 3, SAINT LOUIS, MO 63141-5855
(417) 820-7133
(417) 820-0586
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
107047
MO
261QR1300X
Rural Health Clinic/Center
Primary
—
MO
363A00000X
Physician Assistant
2001029957
MO
363LF0000X
Family Nurse Practitioner
145564
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
596051300
—
MO
Enumeration date
03/09/2007
Last updated
06/11/2018
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