AT DIRECT SPORTS MEDICINE, LLC (NPI# 1720507262) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720507262 |
| Entity Type | Organization |
| Organization Name | AT DIRECT SPORTS MEDICINE, LLC |
| Practice Address |
6424 E Fairfield St Mesa AZ 85205-6042 |
| Practice Telephone | (520) 235-0067 |
| Mailing Telephone | 5202350067 |
| Enumeration Date | 2017-09-15 |
| Last Update Date | 2017-09-15 |
| Authorized Official Name | CASEY ERICKSON (OWNER/ATHLETIC TRAINER) |
| Authorized Official Telephone | 5202350067 |
| Authorized Official Credential | AT |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2083S0010X |
Preventive Medicine Specialization: Sports Medicine |
1318 | AZ | Allopathic & Osteopathic Physicians |
| Street Address |
6424 E FAIRFIELD ST |
| City | MESA |
| State | AZ |
| Zip Code | 85205-6042 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083130199 | Rose Campbell | Technician/Technologist | 649 North Orlando, Mesa, AZ 85205 | 2017-08-21 |
| 1528459781 | Elizabeth Sadler | Nurse Practitioner | 4434 E Brown Rd Ste 102, Mesa, AZ 85205 | 2015-02-10 |
| 1326444324 | Katherine G Perez | Counselor | 152 N Power Rd Ste 2, Mesa, AZ 85205 | 2014-11-18 |
| 1831500800 | C.b.o Hearing | Hearing Aid Equipment | 4406 E. Main St, Suite 103, Mesa, AZ 85205 | 2014-05-13 |
| 1699195107 | Amanda Mcdaniel | Occupational Therapist | 5911 E. Fountain St., Mesa, AZ 85205 | 2014-04-23 |
| 1952640278 | Medstar Medical Transportation LLC | Non-emergency Medical Transport (VAN) | 3932 E Fairfield Cir, Mesa, AZ 85205 | 2013-02-06 |
| 1245575398 | Fabulous Smiles of Mesa | Dentist | 4434 E. Brown Rd, Ste 104, Mesa, AZ 85205 | 2012-11-30 |
| 1992087639 | Matthew Robert Millward | Pharmacist | 1935 N. Power Rd, Mesa, AZ 85205 | 2011-09-19 |
| 1740596733 | Arizona Family & Geriatric Medicine Pllc | Clinic/Center | 5602 E. Main St., Mesa, AZ 85205 | 2010-08-27 |
| 1295049609 | Thomas Chambers | Podiatrist | 5520 E Main St Ste 2, Mesa, AZ 85205 | 2010-07-28 |
| Find all providers in zip 85205 | ||||
| Taxonomy Code | 2083S0010X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Preventive Medicine |
| Specialization | Sports Medicine |
| A preventive medicine physician who specializes in the diagnosis and treatment of sports related conditions and injuries. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A Certification of Added Qualifications (CAQ) is issued by the American Osteopathic Board of Preventive Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700495892 | Modern Sports Medicine LLC | Preventive Medicine | 14821 N Del Webb Blvd, Sun City, AZ 85351-2145 | 2020-07-24 |
| 1528488434 | Cassandra Erickson | Preventive Medicine | 222 W Thomas Rd, Phoenix, AZ 85013-4419 | 2014-04-17 |
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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.