Provider Demographics
NPI:1942259197
Name:SPORTS MEDICINE SPECIALISTS, LLC
Entity Type:Organization
Organization Name:SPORTS MEDICINE SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:B
Authorized Official - Last Name:BETTERIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-227-5208
Mailing Address - Street 1:425 MEDICAL DR
Mailing Address - Street 2:SUITE # 220
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-4945
Mailing Address - Country:US
Mailing Address - Phone:801-735-8826
Mailing Address - Fax:
Practice Address - Street 1:425 MEDICAL DR
Practice Address - Street 2:SUITE # 220
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-4945
Practice Address - Country:US
Practice Address - Phone:801-735-8826
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2948311205207PS0010X
UT58953691205207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports MedicineGroup - Multi-Specialty
Not Answered207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty