Provider Demographics
NPI:1104000561
Name:COMPETITIVE EDGE SPORTS MEDICINE
Entity Type:Organization
Organization Name:COMPETITIVE EDGE SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:NEIGHBORS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-526-2603
Mailing Address - Street 1:9431 HOLY CROSS LN
Mailing Address - Street 2:
Mailing Address - City:BREESE
Mailing Address - State:IL
Mailing Address - Zip Code:62230-3510
Mailing Address - Country:US
Mailing Address - Phone:618-526-2603
Mailing Address - Fax:618-526-1435
Practice Address - Street 1:14160 JAMESTOWN RD
Practice Address - Street 2:
Practice Address - City:BREESE
Practice Address - State:IL
Practice Address - Zip Code:62230
Practice Address - Country:US
Practice Address - Phone:618-526-2603
Practice Address - Fax:618-526-1435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-20
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001400053OtherBCBS