Healthcare Provider Details

I. General information

NPI: 1982626982
Provider Name (Legal Business Name): SPRINGFIELD ORTHOPAEDIC AND SPORTS MEDICINE INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 12/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 W MAIN ST SUITE 100
SPRINGFIELD OH
45502-1312
US

IV. Provider business mailing address

140 W MAIN ST SUITE 100
SPRINGFIELD OH
45502-1312
US

V. Phone/Fax

Practice location:
  • Phone: 937-398-1066
  • Fax: 937-398-1076
Mailing address:
  • Phone: 937-398-1066
  • Fax: 937-398-1076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number35-085484
License Number StateOH

VIII. Authorized Official

Name: DR. IAN M. THOMPSON
Title or Position: OWNER
Credential: M.D.
Phone: 937-398-1066