Provider Demographics
NPI:1285784330
Name:PEDIATRIC ASSOCIATES OF SPRINGFIELD, INC.
Entity type:Organization
Organization Name:PEDIATRIC ASSOCIATES OF SPRINGFIELD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:H
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:417-882-1600
Mailing Address - Street 1:212 E NOTTINGHAM LN
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65810-2629
Mailing Address - Country:US
Mailing Address - Phone:417-882-0449
Mailing Address - Fax:
Practice Address - Street 1:1000 E PRIMROSE ST
Practice Address - Street 2:SUITE 560
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5154
Practice Address - Country:US
Practice Address - Phone:417-882-1600
Practice Address - Fax:417-882-1302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR2B64208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO23264OtherBLUE CHOICE