| Springfield Psychiatry & Addiction Medicine Llc | |
|
3646 S Campbell Ave Springfield MO 65807-5202 | |
| (417) 557-2355 | |
| Not Available |
| Full Name | Springfield Psychiatry & Addiction Medicine Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 3646 S Campbell Ave, Springfield, Missouri |
| Authorized Official Name and Position | Michelle Raymond (CLINIC DIRECTOR) |
| Authorized Official Contact | 4173432577 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Springfield Psychiatry & Addiction Medicine Llc 3646 S Campbell Ave Springfield MO 65807-5202 Ph: (417) 557-2355 | Springfield Psychiatry & Addiction Medicine Llc 3646 S Campbell Ave Springfield MO 65807-5202 Ph: (417) 557-2355 |
| NPI Number | 1427733898 |
|---|---|
| Provider Enumeration Date | 06/21/2023 |
| Last Update Date | 08/25/2023 |
| Certification Date | 08/25/2023 |
| Medicare PECOS PAC ID | 6901267400 |
|---|---|
| Medicare Enrollment ID | O20230801000183 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427733898 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084A0401X | Psychiatry & Neurology - Addiction Medicine | (* (Not Available)) | Primary |
| Provider Name | Erin E Duvall |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003254087 PECOS PAC ID: 5294975348 Enrollment ID: I20130712000428 |
| Provider Name | Mehdi M Tajouri |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1891135430 PECOS PAC ID: 2365758810 Enrollment ID: I20150831000590 |
| Provider Name | Anthony J Alexander |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831676287 PECOS PAC ID: 4486906369 Enrollment ID: I20181003002105 |
| Provider Name | Charles Eli Welch |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1316443856 PECOS PAC ID: 1052646536 Enrollment ID: I20210930001767 |
| Provider Name | Jamie Lynn Carter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134870173 PECOS PAC ID: 9234516279 Enrollment ID: I20220513000629 |
| Provider Name | Dustin M. Mcgill |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730811506 PECOS PAC ID: 9234511940 Enrollment ID: I20220727003369 |
| Provider Name | Oluwatobi Olusholla Aruwajoye |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073221040 PECOS PAC ID: 9638540149 Enrollment ID: I20230120000316 |
| Provider Name | Clayton Allstun Bailey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720716707 PECOS PAC ID: 9234506973 Enrollment ID: I20240227002569 |
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