Provider Demographics
NPI:1265419014
Name:ORTHOPEDICS & SPORTS MEDICINE LTD
Entity type:Organization
Organization Name:ORTHOPEDICS & SPORTS MEDICINE LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:M
Authorized Official - Last Name:MERTENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-933-9393
Mailing Address - Street 1:PO BOX 97618
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89193-7618
Mailing Address - Country:US
Mailing Address - Phone:702-933-9393
Mailing Address - Fax:702-933-6789
Practice Address - Street 1:9499 W CHARLESTON BLVD
Practice Address - Street 2:STE 200
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-7147
Practice Address - Country:US
Practice Address - Phone:702-933-9393
Practice Address - Fax:702-933-6789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-22
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV36575Medicare PIN