Provider Demographics
NPI:1790796480
Name:ULTIMATE SPORTS & ORTHOPAEDICS
Entity Type:Organization
Organization Name:ULTIMATE SPORTS & ORTHOPAEDICS
Other - Org Name:SUMMIT ORTHOPAEDIC ASSOCIATES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-242-4808
Mailing Address - Street 1:15990 TUSCOLA RD
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-2111
Mailing Address - Country:US
Mailing Address - Phone:760-242-4808
Mailing Address - Fax:760-242-4889
Practice Address - Street 1:15990 TUSCOLA RD
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2111
Practice Address - Country:US
Practice Address - Phone:760-242-4808
Practice Address - Fax:760-242-4889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty