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General NPI Number Information
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NPI Number | 1154584308
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Entity Type | Organization
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Legal Business Name | SOUTHERN MISSOURI FAMILY MEDICINE, LLC
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Dates
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Enumeration Date | 07/08/2008
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Last Update Date | 03/17/2010
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Provider Practice Location Address
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Address Line | 1625 GIBSON ST
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City | WEST PLAINS
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State | MO
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Zip | 65775-1873
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Country | US
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Telephone | 417-256-3717
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Fax | 417-256-3738
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Provider Business Mailing Address
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Address Line | 1402 N KENTUCKY AVE
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City | WEST PLAINS
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State | MO
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Zip | 65775-1822
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Country | US
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Telephone | 417-256-3717
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Fax | 417-256-3738
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAMES E THOMPSON
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Credential | M.D.
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Telephone | 417-256-3717
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | R5G97
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License Number State | MO
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