Provider Demographics
NPI:1346646601
Name:THE CENTER FOR SPORTS MEDICINE
Entity Type:Organization
Organization Name:THE CENTER FOR SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISING PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIPLE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:484-472-8812
Mailing Address - Street 1:905 W SPROUL RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SPRINGFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19064-1254
Mailing Address - Country:US
Mailing Address - Phone:484-472-8812
Mailing Address - Fax:
Practice Address - Street 1:905 W SPROUL RD
Practice Address - Street 2:SUITE 106
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064-1254
Practice Address - Country:US
Practice Address - Phone:484-472-8812
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-14
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA003437261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty