| Organization Name: | SOUTHERN MISSOURI FAMILY MEDICINE, LLC |
| NPI Number: | 1154584308 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JAMES E THOMPSON (OWNER) |
| Mailing Address: | 1625 Gibson St West Plains |
| State: | MO US |
| Postal Code: | 657751873 |
| Phone Number: | 4172563717 |
| Fax Number: | 4172563738 |
| NPI Enumeration Date: | 07/08/2008 |
| NPI Last Update Date: | 03/17/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | R5G97 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |