Provider Demographics
NPI:1376642926
Name:MAJOR SPORTS AND MUSCULOSKELETAL CARE
Entity Type:Organization
Organization Name:MAJOR SPORTS AND MUSCULOSKELETAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HORNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-392-3211
Mailing Address - Street 1:1626 E STATE ROAD 44
Mailing Address - Street 2:STE A
Mailing Address - City:SHELBYVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46176-4057
Mailing Address - Country:US
Mailing Address - Phone:317-421-2012
Mailing Address - Fax:
Practice Address - Street 1:157 WEST WASHINGTON
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:IN
Practice Address - Zip Code:46176
Practice Address - Country:US
Practice Address - Phone:317-421-3265
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200475330Medicaid
INH02055Medicare UPIN
IN5127180001Medicare NSC
IN200475330Medicaid