LAGS SPINE AND SPORTSCARE MEDICAL CENTERS, INC. (NPI# 1316411549) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316411549 |
| Entity Type | Organization |
| Organization Name | LAGS SPINE AND SPORTSCARE MEDICAL CENTERS, INC. |
| Practice Address |
592 S 13th St Grover Beach CA 93433-3820 |
| Mailing Address |
218 N I St Lompoc CA 93436-0909 |
| Practice Telephone | 8054736510 |
| Practice Fax Number | 8054736516 |
| Mailing Telephone | 8057367886 |
| Mailing Fax Number | 8057367867 |
| Enumeration Date | 2019-01-22 |
| Last Update Date | 2019-03-06 |
| Authorized Official Name | AMY D'AMATO (CONTRACTS MANAGER) |
| Authorized Official Telephone | 8052643388 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 103TA0400X |
Psychologist Specialization: Addiction (Substance Use Disorder) |
Behavioral Health & Social Service Providers | ||
| N | 1041C0700X |
Social Worker Specialization: Clinical |
Behavioral Health & Social Service Providers | ||
| N | 163WP0808X |
Registered Nurse Specialization: Psych/Mental Health |
Nursing Service Providers | ||
| Y | 2084A0401X |
Psychiatry & Neurology Specialization: Addiction Medicine |
Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912460874 | Lags Spine and Sportscare Medical Centers, Inc. | Physical Medicine & Rehabilitation | 5701 21st Ave W Ste 3, Bradenton, FL 34209-5605 | 2019-04-08 |
| 1174084578 | Lags Spine and Sportscare Medical Centers, Inc. | Physical Medicine & Rehabilitation | 802 Iowa Ave, Los Banos, CA 93635-3450 | 2019-03-28 |
| 1083175483 | Lags Spine and Sportscare Medical Centers, Inc. | Physical Medicine & Rehabilitation | 777 S Ham Ln Ste G, Lodi, CA 95242-3593 | 2019-03-28 |
| 1275090870 | Lags Spine and Sportscare Medical Centers, Inc. | Social Worker | 2651 S C St Ste 200, Oxnard, CA 93033-3560 | 2019-03-01 |
| 1346707114 | Lags Spine and Sportscare Medical Centers, Inc. | Social Worker | 607 Creston Rd, Paso Robles, CA 93446-2775 | 2019-02-27 |
| 1790249894 | Lags Spine and Sportscare Medical Centers, Inc. | Psychologist | 3751 E Shields Avenue, Fresno, CA 93726 | 2019-01-23 |
| 1700357068 | Lags Spine and Sportscare Medical Centers, Inc. | Durable Medical Equipment & Medical Supplies | 3550 Q St Ste 105, Bakersfield, CA 93301-1645 | 2018-12-16 |
| 1487122339 | Lags Spine and Sportscare Medical Centers, Inc. | Physical Medicine & Rehabilitation | 11820 Ne Crestwood Dr Ste 100, Vancouver, WA 98684-5103 | 2018-11-08 |
| 1689157059 | Lags Spine and Sportscare Medical Centers, Inc. | Physical Medicine & Rehabilitation | 801 E Chapel St Ste 6, Santa Maria, CA 93454-4607 | 2018-09-12 |
| 1588147094 | Lags Spine and Sportscare Medical Centers, Inc. | Physical Medicine & Rehabilitation | 803 Coffee Rd Ste 11, Modesto, CA 95355-4244 | 2018-09-11 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | LAGS SPINE AND SPORTSCARE MEDICAL CENTERS, INC | 218 North I Street, Lompoc, CA 93436 |
| Washington State Corporations | LAGS SPINE AND SPORTSCARE MEDICAL CENTERS, INC. | 11820 Ne Crestwood Dr, Vancouver, WA 98684-5102 |
| Street Address |
592 S 13TH ST |
| City | GROVER BEACH |
| State | CA |
| Zip Code | 93433-3820 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417252735 | Lags Spine & Sportscare Medical Centers Inc | Physical Medicine & Rehabilitation | 592 S 13th St, Grover Beach, CA 93433-3820 | 2011-01-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306382783 | Melissa Ann Richardson | Registered Nurse | 286 S. 16th Street, Grover Beach, CA 93433 | 2017-01-10 |
| 1447637475 | Katherine Clair Verwest | Counselor | 1428 Brighton Ave., Grover Beach, CA 93433 | 2015-04-28 |
| 1033552997 | Randall Gaynor Rodman | Dentist | 200 South 13th Street, No 109, Grover Beach, CA 93433 | 2013-04-10 |
| 1154685352 | Allyson N Thompson-knox | Marriage & Family Therapist | 1125 West Grand Avenue, Suite D, Grover Beach, CA 93433 | 2012-07-02 |
| 1851546436 | Jay Alan Turner | Counselor | 1206 Capitola Street, Grover Beach, CA 93433 | 2008-11-24 |
| 1407043862 | Ginette Gallagher II | Public Health or Welfare | 286 So. 16th St, San Luis Obispo County Health Department, Grover Beach, CA 93433 | 2007-10-01 |
| 1700099090 | Cynthia Kae Nelson | Counselor | 767 Ramona Ave, Grover Beach, CA 93433 | 2007-05-07 |
| 1861614158 | Steven Hideki Yoneda | Specialist/Technologist | 1660 Manhattan Avenue, Grover Beach, CA 93433 | 2007-05-03 |
| 1265557136 | Jenna Eyton Wolfson | Social Worker | 901 Ramona Ave # I, Grover Beach, CA 93433 | 2007-03-20 |
| 1922169655 | Donna Maurine Van Pelt | Marriage & Family Therapist | 150b S 6th St, Grover Beach, CA 93433 | 2006-12-13 |
| Find all providers in zip 93433 | ||||
| Taxonomy Code | 2084A0401X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Addiction Medicine |
| A doctor of osteopathy board eligible/certified in the field of Psychiatry by the American Osteopathic Board of Neurology and Psychiatry is able to obtain a Certificate of Added Qualifications in the field of Addiction Medicine |
| Notes: Source: American Osteopathic Board of Neurology and Psychiatry, 2007 [1/1/2008: definition added, source added; 7/1/2011: modified source] - Additional Resources: http://www.osteopathic.org/certification |
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| 1962028936 | Sal Psychiatry Services | Psychiatry & Neurology | 13132 Studebaker Rd Ste 7, Norwalk, CA 90650-2562 | 2020-06-24 |
| 1932768280 | Sprenger Behavioral Medicine, Inc | Psychiatry & Neurology | 7601 Hospital Drive Suite 202, Suite 202, Sacramento, CA 95823 | 2019-06-11 |
| 1609431014 | Vaya Addiction Services | Psychiatry & Neurology | 945 University Ave Ste 101, Sacramento, CA 95825-6712 | 2019-05-01 |
| 1174081327 | Bacchus, Moghaddam, Musngi, Shwayder Medical Corp. | Psychiatry & Neurology | 6801 Park Ter # 530b, Los Angeles, CA 90045-1543 | 2019-03-06 |
| 1104330570 | Integrated Psychiatry, Inc. | Psychiatry & Neurology | 25000 Avenue Stanford Ste 173, Valencia, CA 91355-4596 | 2017-11-21 |
| 1740689694 | Mind & Body Treatment and Research Institute, PC | Psychiatry & Neurology | 5700 Division St, 200, Riverside, CA 92506-3257 | 2014-08-16 |
| 1619311206 | Margaret Barnett Yates | Psychiatry & Neurology | 13847 W Sunset Blvd, Pacific Palisades, CA 90272-4023 | 2013-04-25 |
| 1750645743 | Stefani Lafrenierre | Psychiatry & Neurology | 215 S Hickory St Ste 114, Escondido, CA 92025-4360 | 2012-06-25 |
| 1083977201 | Archangel De Leon | Psychiatry & Neurology | 7466 Sun Castle Ln, Sacramento, CA 95823-6734 | 2012-06-21 |
| Find all providers with the same taxonomy | ||||
| City | GROVER BEACH |
| Zip Code | 93433 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.