26D2285850 CLIA NUMBER - SPRINGFIELD PSYCHIATRY & ADDICTION MEDICINE

Laboratory Demographics

CLIA Number: 26D2285850

Facility Name: SPRINGFIELD PSYCHIATRY & ADDICTION MEDICINE

Facility Address:
3646 S CAMPBELL AVE
SPRINGFIELD, MO
ZIP 65807
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Facility Phone Number: 417 557-2355

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1427733898

Taxonomy: 2084A0401X - Psychiatry & Neurology
A doctor of osteopathy board eligible/certified in the field of Psychiatry by the American Osteopathic Board of Neurology and Psychiatry is able to obtain a Certificate of Added Qualifications in the field of Addiction Medicine

CLIA Record

Field Name	Field Value
CLIA Number	26D2285850
LAB Type	Practitioner Other
Facility Name	SPRINGFIELD PSYCHIATRY & ADDICTION MEDICINE
Street	3646 S CAMPBELL AVE
City	SPRINGFIELD
State	MO
ZIP	65807
Phone	417 557-2355
CertificateType	4
CertificateEffectiveDate	7/19/2023
CertificateExpirationDate	7/18/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024