Provider Demographics
NPI:1336476290
Name:CONSOLIDATED SPORTS MEDICAL ENTERPRISES, INC
Entity Type:Organization
Organization Name:CONSOLIDATED SPORTS MEDICAL ENTERPRISES, INC
Other - Org Name:SPINE & DISC CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MAYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-541-3472
Mailing Address - Street 1:3108 DEL PRADO BLVD S
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-7226
Mailing Address - Country:US
Mailing Address - Phone:239-541-3472
Mailing Address - Fax:239-540-3473
Practice Address - Street 1:3108 DEL PRADO BLVD S
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-7226
Practice Address - Country:US
Practice Address - Phone:239-541-3472
Practice Address - Fax:239-540-3473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-12
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center