Provider Demographics
NPI:1255509717
Name:ALL SPORTS FOUNDATION, INC
Entity Type:Organization
Organization Name:ALL SPORTS FOUNDATION, INC
Other - Org Name:PROSTATE ON-SITE PROJECT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/FOUNDER
Authorized Official - Prefix:MR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:M
Authorized Official - Last Name:FELKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-964-3013
Mailing Address - Street 1:322 E BROWN RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-3563
Mailing Address - Country:US
Mailing Address - Phone:480-964-3013
Mailing Address - Fax:480-964-1644
Practice Address - Street 1:322 E BROWN RD
Practice Address - Street 2:SUITE 103
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-3563
Practice Address - Country:US
Practice Address - Phone:480-964-3013
Practice Address - Fax:480-964-1644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-18
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory