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General NPI Number Information
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NPI Number | 1477579860
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Entity Type | Organization
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Legal Business Name | VAN NESS ORTHOPEDICS & SPORTS MEDICINE INC
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Dates
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Enumeration Date | 07/15/2006
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Last Update Date | 05/22/2024
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Provider Practice Location Address
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Address Line | 606 MAPLE VALLEY DR
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City | FARMINGTON
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State | MO
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Zip | 63640-1976
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Country | US
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Telephone | 573-756-7779
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Fax | 573-756-6914
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Provider Business Mailing Address
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Address Line | 606 MAPLE VALLEY DR
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City | FARMINGTON
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State | MO
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Zip | 63640-1976
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Country | US
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Telephone | 573-756-7779
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Fax | 573-756-6914
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | AMY FORD
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Credential |
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Telephone | 573-756-7779
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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 | DO116378
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License Number State | MO
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