Provider Demographics
NPI:1376907535
Name:ADVANCED CENTER FOR SPORTS & MUSCULOSKELETAL MEDICINE INC
Entity Type:Organization
Organization Name:ADVANCED CENTER FOR SPORTS & MUSCULOSKELETAL MEDICINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:SICKINGER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:760-636-1067
Mailing Address - Street 1:41990 COOK ST # F1006
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-6100
Mailing Address - Country:US
Mailing Address - Phone:760-636-1067
Mailing Address - Fax:760-568-9331
Practice Address - Street 1:41990 COOK ST # F1006
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-6100
Practice Address - Country:US
Practice Address - Phone:760-636-1067
Practice Address - Fax:760-568-9331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-13
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A13043204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Multi-Specialty