Provider Demographics
NPI:1952544926
Name:CENTER FOR SPINE AND SPORTS MEDICINE LLC
Entity Type:Organization
Organization Name:CENTER FOR SPINE AND SPORTS MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:S
Authorized Official - Last Name:HASTETTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-476-7111
Mailing Address - Street 1:7145 E VIRGINIA ST
Mailing Address - Street 2:SUITE 5000
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-9144
Mailing Address - Country:US
Mailing Address - Phone:812-476-7111
Mailing Address - Fax:812-476-7117
Practice Address - Street 1:4199 GATEWAY BLVD
Practice Address - Street 2:SUITE 2000
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-8940
Practice Address - Country:US
Practice Address - Phone:812-476-7111
Practice Address - Fax:812-476-7117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-07
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN253770Medicare PIN