Healthcare Provider Details

I. General information

NPI: 1548180581
Provider Name (Legal Business Name): VALHALLA MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

761 S HICKORY TER
SPRINGFIELD MO
65809-1105
US

IV. Provider business mailing address

761 S HICKORY TER
SPRINGFIELD MO
65809-1105
US

V. Phone/Fax

Practice location:
  • Phone: 417-350-9151
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DAPHNE SIMPSON
Title or Position: PARTNER
Credential: APRN
Phone: 417-350-9051