Basic Information
| Provider Information | |||||||||
| NPI: | 1265702799 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SPRINFIELD CLINIC LLP | ||||||||
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| OtherOrganizationName: | SPRINGFIELD CLINIC MT PULASKI RURAL HEALTH | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1025 S 7TH ST | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 627032416 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2175287541 | ||||||||
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| Practice Location | |||||||||
| Address1: | 509 E CHESTNUT ST | ||||||||
| Address2: | |||||||||
| City: | MOUNT PULASKI | ||||||||
| State: | IL | ||||||||
| PostalCode: | 625481008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2177923756 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/30/2011 | ||||||||
| LastUpdateDate: | 12/30/2011 | ||||||||
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| AuthorizedOfficialLastName: | BRYANT | ||||||||
| AuthorizedOfficialFirstName: | RANDY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2175287541 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.