Provider Demographics
NPI:1356377337
Name:SPORTSMEDCENTRAL
Entity type:Organization
Organization Name:SPORTSMEDCENTRAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MISS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ALFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-343-2300
Mailing Address - Street 1:10233 E NORTHWEST HWY
Mailing Address - Street 2:SUITE 516
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75238-4432
Mailing Address - Country:US
Mailing Address - Phone:214-343-2300
Mailing Address - Fax:214-343-4178
Practice Address - Street 1:10233 E NORTHWEST HWY
Practice Address - Street 2:SUITE 516
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75238-4432
Practice Address - Country:US
Practice Address - Phone:214-343-2300
Practice Address - Fax:214-343-4178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty