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General NPI Number Information
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NPI Number | 1205810553
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Entity Type | Organization
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Legal Business Name | ORTHOPAEDIC ASC OF SPRINGFIELD LLC
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Dates
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Enumeration Date | 11/30/2005
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Last Update Date | 12/17/2007
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Provider Practice Location Address
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Address Line | 3045 S NATIONAL AVE SUITE 101
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City | SPRINGFIELD
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State | MO
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Zip | 65804-4247
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Country | US
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Telephone | 417-447-3910
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Fax | 417-882-5716
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Provider Business Mailing Address
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Address Line | 3045 S NATIONAL AVE SUITE 101
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City | SPRINGFIELD
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State | MO
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Zip | 65804-4247
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Country | US
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Telephone | 417-447-3910
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Fax | 447-882-5716
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Authorized Official
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Title or Position | DIRECTOR OF CLINICAL SERVICES
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Name | JANE MALONE
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Credential | RN
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Telephone | 417-447-3910
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 190-0
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License Number State | MO
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