Provider Demographics
NPI:1194866806
Name:SPORTSMED ORTHOPAEDIC SPECIALISTS, PC
Entity Type:Organization
Organization Name:SPORTSMED ORTHOPAEDIC SPECIALISTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:W
Authorized Official - Last Name:JANSSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-881-5151
Mailing Address - Street 1:1402 COUNTY PARK RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:35769-3967
Mailing Address - Country:US
Mailing Address - Phone:256-259-2838
Mailing Address - Fax:256-259-9438
Practice Address - Street 1:1402 COUNTY PARK RD
Practice Address - Street 2:
Practice Address - City:SCOTTSBORO
Practice Address - State:AL
Practice Address - Zip Code:35769-3967
Practice Address - Country:US
Practice Address - Phone:256-259-2838
Practice Address - Fax:256-259-9438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL4694770002Medicare NSC