Provider Demographics
NPI:1306978911
Name:SPRINGFIELD NEUROLOGICAL INSTITUTE, L.L.C.
Entity type:Organization
Organization Name:SPRINGFIELD NEUROLOGICAL INSTITUTE, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:CRABTREE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:417-885-3888
Mailing Address - Street 1:PO BOX 4024
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65808-4024
Mailing Address - Country:US
Mailing Address - Phone:417-885-3888
Mailing Address - Fax:417-881-7368
Practice Address - Street 1:2900 S NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-3634
Practice Address - Country:US
Practice Address - Phone:417-885-3888
Practice Address - Fax:417-881-7638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR4188130001Medicare NSC
MO4188130001Medicare NSC