Organization
417 SPORTS MEDICINE AND ORTHOPEDICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ERIC GIFFORD MD (PHYSICIAN)
(817) 825-5096
Entity
Organization
Contact information
Practice address
3328 S NATIONAL AVE, SPRINGFIELD, MO 65807-7305
(417) 771-3147
Mailing address
2100 E NORSHIRE ST, SPRINGFIELD, MO 65804-7829
(817) 825-5096
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7860260001
NATIONAL SUPPLIER CLEARING HOUSE
—
Enumeration date
08/17/2020
Last updated
05/16/2024
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