Schedule 4: Non-Covered Clinics & Providers

Effective 03/2019.

Clinic/Provider	Address of Clinic	Phone Number
Clinic/Provider Aids Project of the Ozarks	Address of Clinic 1636 S Glenstone	Phone Number 417-881-1300
Clinic/Provider Arkansas Orthopedics and Sports Medicine	Address of Clinic 224 W. Erie St.	Phone Number 870-741-8289
Clinic/Provider Arquitt Pediatric Dentistry	Address of Clinic 3045 S Delware	Phone Number 417-883-4746
Clinic/Provider Baron Cardiology Group	Address of Clinic 1242 E Independence	Phone Number 417-883-5500
Clinic/Provider Baxley Anesthetics	Address of Clinic 10850 County Lane 253	Phone Number 417-642-5971
Clinic/Provider Branson Clinic, LLC	Address of Clinic 110 Business Park Dr	Phone Number 417-239-0125
Clinic/Provider Branson Dermatology	Address of Clinic 110 Business Park Dr	Phone Number 417-336-0033
Clinic/Provider Branson Nephrology	Address of Clinic 101 Skaggs Rd	Phone Number 417-334-8288
Clinic/Provider Branson Pulmonology & Sleep Medicine	Address of Clinic 875 E State Hwy 76	Phone Number 417-334-5864
Clinic/Provider Breast Care Clinic	Address of Clinic 3850 S National Ave	Phone Number 417-269-6170
Clinic/Provider Brian Dieterle, MD	Address of Clinic 895 State Hwy 248	Phone Number 417-334-0810
Clinic/Provider Brian Tolefree CRNA LLC	Address of Clinic 1136 E 1284 Rd	Phone Number 785-841-5547
Clinic/Provider Bridges Medical Services	Address of Clinic 256 State Hwy Y	Phone Number 417-546-4200
Clinic/Provider Burrell Behavioral Health	Address of Clinic 1300 East Bradford Pkwy	Phone Number 417-761-5000
Clinic/Provider Burrell Clinic	Address of Clinic 509 Dairy St	Phone Number 417-761-5810
Clinic/Provider Butterfield Park Specialty Clinic	Address of Clinic 1245 N Butterfield Rd	Phone Number 417-327-3530
Clinic/Provider Carl Dawson LPC	Address of Clinic 1320 E Kingsley	Phone Number 417-882-4110
Clinic/Provider Carthage Radiology McCune Brooks Hospital	Address of Clinic 3125 Drive Russell Smith Way	Phone Number 417-358-1244
Clinic/Provider Chest & Sleep Institute of Springfield	Address of Clinic 1540 E Evergreen St	Phone Number 417-886-2747
Clinic/Provider Christoffer Weber, MD	Address of Clinic 574 State Hwy 248	Phone Number 417-337-5500
Clinic/Provider Collins Eye Clinic	Address of Clinic 1342 E Primrose	Phone Number 417-869-3200
Clinic/Provider Cox C.A.R.E. Mobile	Address of Clinic 3525 S National Ave	Phone Number 417-269-5944
Clinic/Provider CoxHealth Center for Health Improvement	Address of Clinic 960 E Walnut Lawn Street	Phone Number 417-269-3900
Clinic/Provider CoxHealth Consulting Services & Aviation	Address of Clinic 3555 S National Ave #104	Phone Number 417-269-3319
Clinic/Provider CoxHealth Direct Connect	Address of Clinic 1423 N Jefferson Ave	Phone Number 417-269-8633
Clinic/Provider CoxHealth Occupational Medicine	Address of Clinic 1423 N Jefferson Ave #K500	Phone Number 417-269-3813
Clinic/Provider CoxHealth Occupational Medicine	Address of Clinic 121 Cahill Rd #201 Branson, MO	Phone Number 417-335-7555
Clinic/Provider CoxHealth Pain Management Center	Address of Clinic 1001 E Primrose St 2 West	Phone Number 417-875-3095
Clinic/Provider CoxHealth Quick Care Hy-Vee	Address of Clinic 1720 W Battlefield	Phone Number 417-881-8765
Clinic/Provider Crighton, Olive & Dunn Surgical Group	Address of Clinic 1230 E Kingsley	Phone Number 417-882-2349
Clinic/Provider Deao Anesthetics	Address of Clinic 123 Huntington Cir	Phone Number 913-676-2679
Clinic/Provider Dimmick Laughlin Dermatology LLC	Address of Clinic 1530 E Primrose	Phone Number 417-882-1818
Clinic/Provider Douglas Specialty Clinic	Address of Clinic 1155 W Parkview St	Phone Number 417-328-7000
Clinic/Provider Downtown Medical Associates	Address of Clinic 216 N Main	Phone Number 417-667-3831
Clinic/Provider Dr. Andy Wright	Address of Clinic 1911 S National Ave	Phone Number 417-863-1310
Clinic/Provider Dr. Gil's Immediate Care	Address of Clinic 3000 E Division	Phone Number 417-869-8000
Clinic/Provider Dr. Luke's Family Medicine	Address of Clinic 1015 State Hwy 248	Phone Number 417-337-7511
Clinic/Provider Dr. Robert D. Forsyth	Address of Clinic 4375 E Kingsbury	Phone Number 417-848-9393
Clinic/Provider Edward Gwin, MD	Address of Clinic 2527 E Melbourne Rd	Phone Number 417-883-0479
Clinic/Provider Elite Dental Partners	Address of Clinic 805 Broadway	Phone Number 312-429-7463
Clinic/Provider Evangel University	Address of Clinic 1111 N Glenstone	Phone Number 417-865-2815
Clinic/Provider Eye Surgeons of Springfield Inc	Address of Clinic 1330 E Kingsley	Phone Number 417-887-1965
Clinic/Provider Faith Community Health	Address of Clinic 610 S 6th St	Phone Number 417-336-9355
Clinic/Provider Family Medical Walk-In Clinic	Address of Clinic 4049 S Campbell	Phone Number 417-890-5550
Clinic/Provider Four States Anesthesia Service	Address of Clinic 1905 W 32nd Suite 201	Phone Number 417-206-7900
Clinic/Provider Freeman Health System	Address of Clinic 1102 W 32nd	Phone Number 417-682-3300
Clinic/Provider Garrison Plastic Surgery	Address of Clinic 1530 E Bradford Pkwy	Phone Number 417-877-0630
Clinic/Provider Geoffrey Hudson - Acupuncturist	Address of Clinic 1200 E Woodhurst Dr	Phone Number 417-224-5579
Clinic/Provider Goodin & Martens DDS, PC	Address of Clinic 3850 S National Ave	Phone Number 417-269-7525
Clinic/Provider H. Rex Petesen, DO	Address of Clinic 4040 La Questa Dr	Phone Number 417-451-1833
Clinic/Provider James Bright, MD	Address of Clinic 1736 E Sunshine	Phone Number 417-882-9002
Clinic/Provider James Coulter, MD	Address of Clinic 2733 E Battlefield Rd	Phone Number 417-887-2997
Clinic/Provider John Roller, DPM	Address of Clinic 1691 S Business 65	Phone Number 417-336-3210
Clinic/Provider Jordan Valley Community Health Center - Dental	Address of Clinic 440 E Tampa St	Phone Number 417-831-0150
Clinic/Provider Jordan Valley Community Health Center - Family Medicine, Pediatrics & OB/GYN	Address of Clinic 440 E Tampa St	Phone Number 417-831-0150
Clinic/Provider KC Pathology	Address of Clinic 7800 W 110th St	Phone Number 913-338-4070
Clinic/Provider Lakes Region Imaging	Address of Clinic 525 Branson Landing Blvd	Phone Number 417-335-7223
Clinic/Provider Leo Martinez LCSW Psychological Services	Address of Clinic 1150 State Hwy 248	Phone Number 417-348-8964
Clinic/Provider Leo Tokarczyk, DDS	Address of Clinic 4777 S National Ave	Phone Number 417-882-2880
Clinic/Provider Litton & Giddings Radiological Associates	Address of Clinic 3801 S National Ave	Phone Number 417-269-4056
Clinic/Provider Mary's Well House	Address of Clinic 5136 State Hwy 265	Phone Number 417-338-0960
Clinic/Provider Mattax, Neu, Prater Eye Center	Address of Clinic 1265 E Primrose St	Phone Number 417-886-3937
Clinic/Provider McShane Foot & Ankle Clinic	Address of Clinic 1834 S Stewart Ave	Phone Number 417-889-3338
Clinic/Provider Mercy Clinic - Ear, Nose & Throat	Address of Clinic 1229 E Seminole	Phone Number 417-820-5750
Clinic/Provider Mercy Clinic - Eye Specialists	Address of Clinic 1229 E Seminole	Phone Number 417-820-9393
Clinic/Provider Mercy Clinic - OB/GYN	Address of Clinic 3231 S National Ave	Phone Number 417-885-0827
Clinic/Provider Mercy Clinic Family Medicine Monett	Address of Clinic 315 E Cleveland	Phone Number 417-235-4334
Clinic/Provider Michael Hanks, MD	Address of Clinic 1000 E Primrose	Phone Number 417-269-2300
Clinic/Provider Missouri Eye Institute	Address of Clinic 1531 E Bradford Pkwy, Springfield, MO	Phone Number 417-887-3900
Clinic/Provider Missouri Eye Institute	Address of Clinic 1000 James F Epps Rd Branson, MO	Phone Number 417-887-3900
Clinic/Provider MRI of Springfield	Address of Clinic 1420 E Bradford Pkwy	Phone Number 417-885-1100
Clinic/Provider Mt Vernon Clinic	Address of Clinic 1011 S East St	Phone Number 417-466-7191
Clinic/Provider Neurological Associates of the Four States	Address of Clinic 1102 Rustic Ridge	Phone Number 417-627-9994
Clinic/Provider Obstetrics and Pediatrics Subspecialty Group	Address of Clinic 10550 Quivira Rd	Phone Number 816-816-3470
Clinic/Provider Oncology Hematology Associates	Address of Clinic 3850 S National Ave	Phone Number 417-882-4880
Clinic/Provider Oral & Maxillofacial Surgery Group	Address of Clinic 1103 E Montclair St	Phone Number 417-887-8800
Clinic/Provider Oral Surgery & Dental Implant Center of the Ozarks	Address of Clinic 3820 S Fremont	Phone Number 417-882-0948
Clinic/Provider Oral Surgery of Springfield	Address of Clinic 3237 E Sunshine	Phone Number 417-881-4546
Clinic/Provider Ozark Anesthesia Associates	Address of Clinic 1000 E Primrose	Phone Number 417-269-4550
Clinic/Provider Ozark Community Hospital-Webster County	Address of Clinic 101 S Main	Phone Number 417-753-9404
Clinic/Provider Ozark Mountain Ear, Nose & Throat	Address of Clinic 186 S Payne Stewart Dr	Phone Number 417-335-3636
Clinic/Provider Ozark Prosthetics & Orthotics	Address of Clinic 3250 S Delaware	Phone Number 417-889-3222
Clinic/Provider Ozark Retina & Macula	Address of Clinic 1230 E Kingsley St	Phone Number 417-720-4916
Clinic/Provider Ozarks Community Hospital - Evergreen Clinic	Address of Clinic 1540 E Evergreen	Phone Number 417-823-2900
Clinic/Provider Ozarks Community Hospital South	Address of Clinic 105 A Ridgecrest Ave	Phone Number 417-725-8250
Clinic/Provider Ozarks Dermatology Specialists	Address of Clinic 3808 S Greystone Ct	Phone Number 417-889-3332
Clinic/Provider Ozarks Family Health LLC	Address of Clinic 4941 N Town Centre Dr	Phone Number 417-551-4810
Clinic/Provider Parkcrest Dental Group	Address of Clinic 540 W LaSalle	Phone Number 417-887-1220
Clinic/Provider Pathological Services of Springfield	Address of Clinic 1000 E Primrose	Phone Number 417-269-4646
Clinic/Provider Pediatric Associates	Address of Clinic 1000 E Primrose	Phone Number 417-882-1600
Clinic/Provider Pediatrix Cardiology of Springfield	Address of Clinic 1135 E Lakewood St	Phone Number 417-447-4700
Clinic/Provider Physicians for Breast Health LLC	Address of Clinic 3850 S National Ave	Phone Number 417-269-6170
Clinic/Provider Primrose Nephrology	Address of Clinic 1540 E Evergreen	Phone Number 417-823-2900
Clinic/Provider Putnam Orthopaedic Center LLC	Address of Clinic 4350 S National Ave	Phone Number 417-447-1000
Clinic/Provider Reynolds Plastic Surgery, LLC	Address of Clinic 1531 E Bradford Pkwy	Phone Number 417-823-9777
Clinic/Provider Scott-Larson, Inc	Address of Clinic 1246 E Walnut Lawn	Phone Number 417-755-7430
Clinic/Provider Southwest Missouri Foot Specialist	Address of Clinic 2828 N National Ave	Phone Number 417-837-4191
Clinic/Provider Southwest Missouri Forensics	Address of Clinic 1930 E Meadowmere St	Phone Number 417-725-2157
Clinic/Provider Springfield Nephrology	Address of Clinic 1911 S National Ave	Phone Number 417-886-5000
Clinic/Provider Springfield OB/GYN, LLC	Address of Clinic 909 E Montclair St	Phone Number 417-882-4466
Clinic/Provider Steven Atwood, MD	Address of Clinic 3525 S National Ave	Phone Number 417-269-9200
Clinic/Provider Swann Dermatology Surgery	Address of Clinic 3850 S National Ave	Phone Number 417-888-0858
Clinic/Provider Taylor Health Clinic - Family Medicine	Address of Clinic 901 S National Ave	Phone Number 417-836-4000
Clinic/Provider Taylor Health Clinic - Internal Medicine	Address of Clinic 901 S National Ave	Phone Number 417-836-4041
Clinic/Provider TerraGreen Dental	Address of Clinic 2305 S Blackman Rd	Phone Number 417-887-3860
Clinic/Provider The Clinic at Wal-Mart Operated by CoxHealth	Address of Clinic Regional Services	Phone Number 417-269-4343
Clinic/Provider The Foot Doctors	Address of Clinic 929 E Montclair St	Phone Number 417-883-1881
Clinic/Provider The Smile Spot	Address of Clinic 1324 E Montclair St	Phone Number 417-886-9939
Clinic/Provider The Urology Group	Address of Clinic 3850 S National Ave	Phone Number 417-269-6944
Clinic/Provider Tom Quinn, DDS	Address of Clinic 948 S Jefferson	Phone Number 417-865-8405
Clinic/Provider Tri Lakes Community Health Center	Address of Clinic 11863 State Hwy 13	Phone Number 417-739-1995
Clinic/Provider Tri-Lake Eye Center	Address of Clinic 915 State Hwy 248 Ste A	Phone Number 417-334-0044
Clinic/Provider Tri-Lakes Pathology	Address of Clinic 525 Branson Landing Blvd	Phone Number 417-335-7254
Clinic/Provider Troy Major, MD	Address of Clinic 1000 E Primrose	Phone Number 417-881-7220
Clinic/Provider Virtual Radiological Professionals LLC	Address of Clinic 3801 S National Ave	Phone Number 417-269-4056
Clinic/Provider Virtual Radiological Services	Address of Clinic 3801 S National Ave	Phone Number 417-269-4056
Clinic/Provider Vision Solutions	Address of Clinic 808 Gulf	Phone Number 417-323-5674
Clinic/Provider Washington University Pediatric Epilepsy Center	Address of Clinic 1 Children's Place #2C St. Louis MO	Phone Number 314-454-2694
Clinic/Provider White River Anesthesia Associates, Inc	Address of Clinic PO Box 1308	Phone Number 417-239-3392
Clinic/Provider Wm. Scott Magill, DO	Address of Clinic 4730 S National Ave #B3	Phone Number 417-886-8898
Clinic/Provider Women's Clinic	Address of Clinic 5571 Gretna Rd	Phone Number 417-334-7277