Provider Demographics
NPI:1962485607
Name:MSM PARTNERSHIP
Entity Type:Organization
Organization Name:MSM PARTNERSHIP
Other - Org Name:SPORTSMED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:F
Authorized Official - Last Name:SPEAR
Authorized Official - Suffix:
Authorized Official - Credentials:MS,RN,ATC
Authorized Official - Phone:740-374-3200
Mailing Address - Street 1:160 GROSS ST
Mailing Address - Street 2:FRONTIER SHOPPING CENTER
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-2031
Mailing Address - Country:US
Mailing Address - Phone:740-374-3200
Mailing Address - Fax:740-374-9560
Practice Address - Street 1:160 GROSS ST
Practice Address - Street 2:FRONTIER SHOPPING CENTER
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-2031
Practice Address - Country:US
Practice Address - Phone:740-374-3200
Practice Address - Fax:740-374-9560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-28
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9931761Medicare ID - Type Unspecified
OH0169700001Medicare NSC