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General NPI Number Information
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NPI Number | 1730202078
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Entity Type | Organization
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Legal Business Name | STARKVILLE ORTHOPEDIC CLINIC, LLC
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Dates
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Enumeration Date | 04/10/2007
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Last Update Date | 05/20/2013
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Provider Practice Location Address
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Address Line | 100 WILBURN WAY
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City | STARKVILLE
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State | MS
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Zip | 39759-3692
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Country | US
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Telephone | 662-320-4008
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Fax | 662-320-2450
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Provider Business Mailing Address
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Address Line | 100 WILBURN WAY
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City | STARKVILLE
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State | MS
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Zip | 39759
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Country | US
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Telephone | 662-320-4008
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Fax | 662-320-2450
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | WILLIAM TODD SMITH
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Credential | M.D.
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Telephone | 662-320-4008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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