Provider Demographics
NPI:1043957657
Name:JAB SPORTS MEDICINE & DIRECT PRIMARY CARE PC
Entity Type:Organization
Organization Name:JAB SPORTS MEDICINE & DIRECT PRIMARY CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:MD, CAQSM, MBA
Authorized Official - Phone:219-292-4973
Mailing Address - Street 1:8049 W 85TH CT
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-8981
Mailing Address - Country:US
Mailing Address - Phone:219-292-4973
Mailing Address - Fax:219-301-1158
Practice Address - Street 1:5521 W LINCOLN HWY STE 230
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-1097
Practice Address - Country:US
Practice Address - Phone:219-301-1158
Practice Address - Fax:219-301-1158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Single Specialty