NPIMap

Myron W. Mizell, MD

Individual provider Active NPI Cardiovascular Disease Physician · Springfield, MO

NPI 1154410173 · NPPES record last updated May 16, 2013

Key facts

NPI
1154410173
Entity type
Individual (NPI type 1)
Primary specialty
Cardiovascular Disease Physician 207RC0000X
License
R5326 (MO)
Practice address
2115 S Fremont Ave
Suite 4300
Springfield, MO 65804-2239
Phone
(417) 820-3911
Fax
(417) 820-3924
NPI assigned
Oct 11, 2006
Sex
Male
Sole proprietor
No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
Yes
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Ozarks Medical Center Past Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X R5326 MO Yes

Addresses

Primary practice location

2115 S Fremont Ave
Suite 4300
Springfield, MO 65804-2239

Mailing address

PO Box 2580
Springfield, MO 65801-2580
Phone (417) 829-4620

Other identifiers

IdentifierTypeStateIssuer
200946556MedicaidMO

Other providers in Springfield, MO

All providers in Springfield, MO · Cardiovascular Disease Physician in Missouri

Sources for this page

Verify at the official NPI Registry.