Organization
417 SPORTS ADVANCED IMAGING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERIC GIFFORD MD (OWNER)
(417) 771-3147
Entity
Organization
Contact information
Practice address
3328 S NATIONAL AVE, SPRINGFIELD, MO 65807-7305
(417) 771-3147
Mailing address
3328 S NATIONAL AVE, SPRINGFIELD, MO 65807-7305
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Enumeration date
10/28/2025
Last updated
10/28/2025
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