417 SPORTS MEDICINE AND ORTHOPEDICS LLC (NPI# 1871105312) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1871105312 |
| Entity Type | Organization |
| Organization Name | 417 SPORTS MEDICINE AND ORTHOPEDICS LLC |
| Practice Address |
330 W Plainview Rd Ste F Springfield MO 65810-2672 |
| Mailing Address |
2100 E Norshire St Springfield MO 65804-7829 |
| Practice Telephone | 4177713147 |
| Mailing Telephone | 8178255096 |
| Enumeration Date | 2020-08-17 |
| Last Update Date | 2020-09-04 |
| Authorized Official Name | DR. ERIC GIFFORD (PHYSICIAN) |
| Authorized Official Telephone | 8178255096 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207QS0010X |
Family Medicine Specialization: Sports Medicine |
Allopathic & Osteopathic Physicians |
| Street Address |
330 W PLAINVIEW RD STE F |
| City | SPRINGFIELD |
| State | MO |
| Zip Code | 65810-2672 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508373838 | Sunterra Springfield Oc, LLC | Skilled Nursing Facility | 4935 S National Ave, Springfield, MO 65810 | 2018-01-09 |
| 1982119392 | Boyoung Park | Specialist/Technologist | 4355 S National Ave Apt 905, Springfield, MO 65810 | 2017-12-07 |
| 1578086310 | Missouri Telerad LLC | Radiology | 5117 South Neffleton Avenue, Springfiled, MO 65810 | 2017-07-24 |
| 1245597285 | Intrepid of Missouri, Inc. | Hospice Care, Community Based | 4305 S. National Ave., Springfield, MO 65810 | 2012-04-16 |
| 1700199668 | Telerad of Mo Account Management, LLC | Radiology | 5117 S. Neffleton Ave, Springfield, MO 65810 | 2010-07-21 |
| 1427286251 | Sam's Club Optical | Eyewear Supplier (Equipment, not the service) | 745 W El Camino Alto Drive, Springfield (s), MO 65810 | 2009-07-01 |
| 1033344304 | Teresa Mary Kaelin | Occupational Therapist | 3291 W. Ridge Run, Springfield, MO 65810 | 2009-05-15 |
| 1538366448 | Rani K Nair | Internal Medicine | 3231 S National Mercy Endocrineology, Ste 440, Springfield, MO 65810 | 2007-07-03 |
| 1467672519 | Missouri Dental Professionals, Richard Straus, Dmd, PC | Dentist | 4955 S. National Ave., Unit A, Springfield, MO 65810 | 2007-04-30 |
| 1336161983 | Leo Allan Tokarczyk | Dentist | 4777 S National Ave, Springfield, MO 65810 | 2006-07-24 |
| Find all providers in zip 65810 | ||||
| Taxonomy Code | 207QS0010X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Specialization | Sports Medicine |
| A family medicine physician that is trained to be responsible for continuous care in the field of sports medicine, not only for the enhancement of health and fitness, but also for the prevention of injury and illness. A sports medicine physician must have knowledge and experience in the promotion of wellness and the prevention of injury. Knowledge about special areas of medicine such as exercise physiology, biomechanics, nutrition, psychology, physical rehabilitation, epidemiology, physical evaluation, injuries (treatment and prevention and referral practice) and the role of exercise in promoting a healthy lifestyle are essential to the practice of sports medicine. The sports medicine physician requires special education to provide the knowledge to improve the health care of the individual engaged in physical exercise (sports) whether as an individual or in team participation. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Family Medicine, 2007. http://www.theabfm.org/. American Osteopathic Board of Family Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922377274 | Duocorp Enterprises, LLC | Family Medicine | 1525 E Republic Rd, Suite A115, Springfield, MO 65804-6527 | 2011-12-15 |
| 1639137326 | Brian J Shiple | Family Medicine | 905 W Sproul Rd, Suite 106, Springfield, PA 19064-1254 | 2006-05-02 |
| 1629575204 | Kennneth Joseph Santello | Family Medicine | 196 W Sproul Rd, Springfield, PA 19064-2045 | 2018-04-10 |
| 1528413002 | Prospect Health Access Network, Inc. | Family Medicine | 196 W Sproul Rd, Suite 110, Springfield, PA 19064-2045 | 2016-05-03 |
| 1477932762 | David Baxter | Family Medicine | 1260 E Woodland Ave, Suite 200, Springfield, PA 19064-3969 | 2015-05-20 |
| 1417278789 | Kevin Duprey | Family Medicine | 196 W Sproul Rd, Suite 110, Springfield, PA 19064-2045 | 2010-06-21 |
| 1467608950 | The Center for Sports Medicine, Brian J. Shiple D.o., LLC | Family Medicine | 905 W Sproul Rd, Suite 106, Springfield, PA 19064-1254 | 2008-08-15 |
| 1740448745 | Thomas John Duhig | Family Medicine | 800 N 1st St, Springfield, IL 62702 | 2008-05-27 |
| 1801084736 | Rishi Sharma | Family Medicine | 800 N 1st St, Springfield, IL 62702-3719 | 2007-10-04 |
| 1184814576 | Shannon Lee Woods | Family Medicine | 3555 S National Ave, Springfield, MO 65807-7310 | 2007-07-31 |
| Find all providers in SPRINGFIELD | ||||
| City | SPRINGFIELD |
| Zip Code | 65810 |
Please comment or provide details below to improve the information on 417 SPORTS MEDICINE AND ORTHOPEDICS LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.