Provider Demographics
NPI:1750823894
Name:S.O.A.R SPORT MEDICINE LLC
Entity Type:Organization
Organization Name:S.O.A.R SPORT MEDICINE LLC
Other - Org Name:AVENTUS PAIN AND SPINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:NAGI
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUSSEF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-356-1454
Mailing Address - Street 1:7560 RED BUG LAKE RD STE 2014
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-6562
Mailing Address - Country:US
Mailing Address - Phone:407-951-5833
Mailing Address - Fax:888-972-3696
Practice Address - Street 1:7560 RED BUG LAKE RD STE 2010
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-6591
Practice Address - Country:US
Practice Address - Phone:407-951-5833
Practice Address - Fax:888-972-3696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-07
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty