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General NPI Number Information
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NPI Number | 1407032287
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Entity Type | Organization
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Legal Business Name | SOUTHERN MISSOURI ORTHOPAEDICS AND SPORTS MEDICINE CLINIC
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Dates
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Enumeration Date | 01/11/2008
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Last Update Date | 02/26/2008
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Provider Practice Location Address
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Address Line | 1609 PORTER WAGONER BLVD
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City | WEST PLAINS
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State | MO
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Zip | 65775-1805
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Country | US
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Telephone | 417-255-2880
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Fax | 417-255-2860
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Provider Business Mailing Address
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Address Line | PO BOX 586
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City | WEST PLAINS
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State | MO
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Zip | 65775-0586
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Country | US
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Telephone | 417-255-2880
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Fax | 417-255-2860
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Authorized Official
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Title or Position | ORTHOPAEDIC PHYSICIAN
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Name | DR. RICK B WALKER
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Credential | D.O.
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Telephone | 417-255-2880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | R8G91
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License Number State | MO
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