Organization · NPI-2

417 Sports Advanced Imaging LLC

Radiology, Diagnostic Radiology · Springfield, MO

NPI number1225906597
StatusActive
Last updated in NPPESOct 28, 2025

Details

NPI
1225906597
Entity type
Organization (NPI-2)
Legal business name
417 Sports Advanced Imaging LLC
Organization subpart
No
Enumeration date
Oct 28, 2025
Certification date
Oct 28, 2025
Last updated
Oct 28, 2025

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
2085R0202X Radiology, Diagnostic Radiology––Yes

Practice location

3328 S National Ave
Springfield, MO 65807-7305

Phone 417-771-3147

Mailing address

3328 S National Ave
Springfield, MO 65807-7305

Authorized official

Eric Gifford
Owner
4177713147

Is something wrong?

This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.

Other Radiology, Diagnostic Radiology providers in Springfield, MO