Provider Demographics
NPI:1306000534
Name:SPORT & SPINE CLINIC L.P.
Entity Type:Organization
Organization Name:SPORT & SPINE CLINIC L.P.
Other - Org Name:SPORT & SPINE-RIB MOUNTAIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BINSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-297-7000
Mailing Address - Street 1:PO BOX 1349
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54402-1349
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:226831 RIB MOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-3350
Practice Address - Country:US
Practice Address - Phone:715-359-2500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-16
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI526555Medicare Oscar/Certification