Provider Demographics
NPI:1497817027
Name:AWH OF SPRINGFIELD, LLC.
Entity type:Organization
Organization Name:AWH OF SPRINGFIELD, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:MAGILL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:417-886-8898
Mailing Address - Street 1:1536 E PRIMROSE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804
Mailing Address - Country:US
Mailing Address - Phone:417-886-8898
Mailing Address - Fax:417-886-5775
Practice Address - Street 1:1536 E PRIMROSE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-7928
Practice Address - Country:US
Practice Address - Phone:417-886-8898
Practice Address - Fax:417-886-5775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR2J57174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty