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General NPI Number Information
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NPI Number | 1801076369
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Entity Type | Organization
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Legal Business Name | SPRINGFIELD SPINE & SPORT, INC.
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Dates
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Enumeration Date | 11/13/2007
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 4960 MIDDLE URBANA RD
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City | SPRINGFIELD
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State | OH
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Zip | 45503-6040
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Country | US
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Telephone | 937-399-8366
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Fax | 937-399-8379
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Provider Business Mailing Address
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Address Line | 4960 MIDDLE URBANA RD
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City | SPRINGFIELD
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State | OH
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Zip | 45503-6040
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Country | US
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Telephone | 937-399-8366
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Fax | 937-399-8379
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. PAMELA K GOTHARD
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Credential |
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Telephone | 937-399-8366
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 35067942
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License Number State | OH
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