Organization · NPI-2

417 Sports Medicine And Orthopedics LLC

Family Medicine, Sports Medicine · Springfield, MO

NPI number1871105312
StatusActive
Last updated in NPPESMay 16, 2024

Details

NPI
1871105312
Entity type
Organization (NPI-2)
Legal business name
417 Sports Medicine And Orthopedics LLC
Organization subpart
No
Enumeration date
Aug 17, 2020
Certification date
May 16, 2024
Last updated
May 16, 2024

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207QS0010X Family Medicine, Sports Medicine––Yes

Practice location

3328 S National Ave
Springfield, MO 65807-7305

Phone 417-771-3147

Mailing address

2100 E Norshire St
Springfield, MO 65804-7829

Phone 817-825-5096

Authorized official

Eric Gifford
Physician
8178255096

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