Provider Demographics
NPI:1063487577
Name:SPORTS MEDICINE ASSOCIATES P.C.
Entity Type:Organization
Organization Name:SPORTS MEDICINE ASSOCIATES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:T
Authorized Official - Last Name:HESTER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:617-739-2003
Mailing Address - Street 1:PO BOX 2200
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NH
Mailing Address - Zip Code:03031-4200
Mailing Address - Country:US
Mailing Address - Phone:603-673-9411
Mailing Address - Fax:603-673-9899
Practice Address - Street 1:830 BOYLSTON ST
Practice Address - Street 2:SUITE 205
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02467-2503
Practice Address - Country:US
Practice Address - Phone:617-739-2003
Practice Address - Fax:617-734-0242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-19
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0021510OtherNEIGHBORHOOD HEALTH PLAN
MA49108OtherFALLON COMMUNITY HEALTH
MAM17672OtherBCBS OF MA
MAVC6000189233OtherMA WORKERS COMPENSATION
MA687403OtherTUFTS HEALTH PLAN
103363500OtherFEDERAL WORKERS COMP
MA9703420Medicaid
MA2436362OtherAETNA
MAM20889Medicare ID - Type Unspecified
MA2436362OtherAETNA
MA9703420Medicaid