Provider Demographics
NPI:1609065218
Name:MT VERNON SPORTS AND FAMILY MEDICINE LLC
Entity Type:Organization
Organization Name:MT VERNON SPORTS AND FAMILY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:STURMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-392-8001
Mailing Address - Street 1:1320 COSHOCTON AVE
Mailing Address - Street 2:STE E
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-6400
Mailing Address - Country:US
Mailing Address - Phone:740-392-8001
Mailing Address - Fax:740-392-8008
Practice Address - Street 1:1320 COSHOCTON AVE
Practice Address - Street 2:STE E
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-6400
Practice Address - Country:US
Practice Address - Phone:740-392-8001
Practice Address - Fax:740-392-8008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-19
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35060676207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHY01482Medicare UPIN
OH9340201Medicare PIN