Provider Demographics
NPI:1558780122
Name:HORRELL, WILLIAM (CPO)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:HORRELL
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 S KANSAS EXPY
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-5969
Mailing Address - Country:US
Mailing Address - Phone:417-883-5522
Mailing Address - Fax:417-883-2987
Practice Address - Street 1:3003 S KANSAS EXPY
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5969
Practice Address - Country:US
Practice Address - Phone:417-883-5522
Practice Address - Fax:417-883-2987
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-10
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier