Provider Demographics
NPI:1477073617
Name:INERTIA SPORTS AND FAMILY MEDICINE, PLLC
Entity Type:Organization
Organization Name:INERTIA SPORTS AND FAMILY MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALYSIA
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:BEDGOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-413-1402
Mailing Address - Street 1:189 MCGARITY
Mailing Address - Street 2:
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640-5887
Mailing Address - Country:US
Mailing Address - Phone:512-413-1402
Mailing Address - Fax:512-328-5500
Practice Address - Street 1:115 KOHLERS XING STE 200
Practice Address - Street 2:
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-2461
Practice Address - Country:US
Practice Address - Phone:512-300-0970
Practice Address - Fax:866-358-3313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-20
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN9171207Q00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty