Southwest Missouri Infectious Disease LLC

Primary specialty

Infectious Disease PhysicianTaxonomy code 207RI0200X

License

2004006990 Issued in MO

Legal business name

SOUTHWEST MISSOURI INFECTIOUS DISEASE LLC

Practice address

2872 S Forrest Heights Ave
Springfield, MO 65809-3417

Phone

(417) 459-1711

NPI assigned

Feb 23, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Eric Jerome Fulnecky, M.D.NPI 1922176635

Title

Owner

Phone

(417) 459-1711

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Eric J. Fulnecky, MD

  • Infectious Disease Physician
  • Springfield, MO
  • NPI 1922176635
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1487808000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487808000000",
    "number": "1396284303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2872 S FORREST HEIGHTS AVE",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658093417",
            "telephone_number": "417-459-1711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2872 S FORREST HEIGHTS AVE",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658093417",
            "telephone_number": "417-459-1711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWEST MISSOURI INFECTIOUS DISEASE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-23",
        "last_updated": "2017-02-23",
        "status": "A",
        "authorized_official_last_name": "FULNECKY",
        "authorized_official_first_name": "ERIC",
        "authorized_official_middle_name": "JEROME",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "417-459-1711",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RI0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "MO",
            "license": "2004006990",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Southwest Center for Independent Living
• Southwest Childrens LLC
• Southwest Missouri Homecare, LLC
• Southwest Missouri Homecare, LLC
• Southwest Missouri Homecare, LLC
• Southwest Missouri Pediatric Speech Therapy LLC
• Southwestern Womens Health LLC
• Joshua Keith Soward I, M.A.
• Richard A Sowell, MA, LPC
• Diana J Spade, MD

• Infectious Disease Physician in Springfield, MO
• Providers in Springfield, MO by specialty
• Infectious Disease Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.