Provider Demographics
NPI:1043529696
Name:SPORTSCARE PHYSICIANS
Entity Type:Organization
Organization Name:SPORTSCARE PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCUNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-824-7264
Mailing Address - Street 1:2865 N REYNOLDS RD STE 140
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-2069
Mailing Address - Country:US
Mailing Address - Phone:419-578-7590
Mailing Address - Fax:419-537-5605
Practice Address - Street 1:2865 N REYNOLDS RD STE 140
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-2069
Practice Address - Country:US
Practice Address - Phone:419-578-7590
Practice Address - Fax:419-537-5605
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE TOLEDO HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports MedicineGroup - Single Specialty