| NPI | 1396144341 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRAVIS D RICHARDSON Doctor Of Osteopathic Medicine 870-239-8102 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine (Licence: AR e4201) |
| Additional Taxonomies | 332BX2000X Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies |
| Enumeration Date | 2014-08-15 |
| Last Update Date | 2020-04-24 |