Provider Demographics
NPI:1356657050
Name:BALD SPOT RACING, LLC
Entity Type:Organization
Organization Name:BALD SPOT RACING, LLC
Other - Org Name:BALD SPOT SPORTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:COBB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-705-2880
Mailing Address - Street 1:17715 COMMERCE DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WESTFEILD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-8972
Mailing Address - Country:US
Mailing Address - Phone:317-402-7188
Mailing Address - Fax:
Practice Address - Street 1:17715 COMMERCE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:WESTFIELD
Practice Address - State:IN
Practice Address - Zip Code:46074-8971
Practice Address - Country:US
Practice Address - Phone:317-537-7328
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-19
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment