Organization
MERCY CLINIC SPRINGFIELD COMMUNITIES
Active
Other names
Mercy Clinic Family Medicine-Willow Springs
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT CAVAGNOL (CHIEF PHYSICIAN OFFICER)
(417) 820-2705
Entity
Organization
Contact information
Practice address
1202 E MAIN ST, WILLOW SPRINGS, MO 65793
(417) 469-1820
(417) 469-5280
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
2009010253
MO
261QR1300X
Rural Health Clinic/Center
Primary
—
MO
363LF0000X
Family Nurse Practitioner
2013019442
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1972771657
RURAL HEALTH MEDICAID
MO
Enumeration date
02/14/2008
Last updated
12/04/2018
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