SPINE SPORTS AND PAIN MEDICINE, PC (NPI# 1750516704) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1750516704 |
| Entity Type | Organization |
| Organization Name | SPINE SPORTS AND PAIN MEDICINE, PC |
| Other Organization Name | DOCTORS MEDICAL EQUIPMENT |
| Practice Address |
7900 W Jefferson Blvd Suite 304 Fort Wayne IN 46804-4128 |
| Mailing Address |
Po Box 8857 Fort Wayne IN 46898-8857 |
| Practice Telephone | 2609696200 |
| Practice Fax Number | 2609696201 |
| Mailing Telephone | 2609696200 |
| Mailing Fax Number | 2609696201 |
| Enumeration Date | 2009-05-20 |
| Last Update Date | 2009-05-20 |
| Authorized Official Name | MATTHEW CAVACINI (CEO) |
| Authorized Official Telephone | 2609696200 |
| Is Organization Subpart | Y |
| Parent Organization Name | SPINE SPORTS AND PAIN MEDICINE, PC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332B00000X | Durable Medical Equipment & Medical Supplies | 50004446A | IN | Suppliers |
| Other Name | Type Code |
|---|---|
| Doctors Medical Equipment | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780819755 | Spine Sports and Pain Medicine, PC | Clinical Medical Laboratory | 7900 W Jefferson Blvd, Fort Wayne, IN 46804-4128 | 2009-05-20 |
| Street Address |
7900 W JEFFERSON BLVD SUITE 304 |
| City | FORT WAYNE |
| State | IN |
| Zip Code | 46804-4128 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497744437 | Valerie D. Stogdill | Physician Assistant | 7900 W Jefferson Blvd, Suite 201, Fort Wayne, IN 46804-4128 | 2005-10-20 |
| 1922556752 | Carole E. Slater | Registered Nurse | 7900 W Jefferson Blvd, Suite 201, Fort Wayne, IN 46804-4128 | 2016-09-21 |
| 1144694464 | Kendall S. Ray | Dietitian, Registered | 7900 W Jefferson Blvd, Suite 201, Fort Wayne, IN 46804-4128 | 2015-11-24 |
| 1548529084 | Beverly L. Mauger | Nurse Practitioner | 7900 W Jefferson Blvd, Suite 304, Fort Wayne, IN 46804-4128 | 2012-05-03 |
| 1679857502 | Sara J Nevil | Nurse Practitioner | 7900 W Jefferson Blvd, Suite 304, Fort Wayne, IN 46804-4128 | 2011-10-11 |
| 1043592033 | Kelly A Anderson | Nurse Practitioner | 7900 W Jefferson Blvd, Suite 304, Fort Wayne, IN 46804-4128 | 2011-09-15 |
| 1336460161 | Charles Lee Copeland | Physician Assistant | 7900 W Jefferson Blvd, Suite 304, Fort Wayne, IN 46804-4128 | 2010-06-16 |
| 1679805048 | Michelle Ann Parra | Nurse Practitioner | 7900 W Jefferson Blvd, Ste 304, Fort Wayne, IN 46804-4128 | 2010-02-09 |
| 1861624587 | Benjamin P Merchant | Physical Therapist | 7900 W Jefferson Blvd, Suite 304, Fort Wayne, IN 46804-4128 | 2009-08-13 |
| 1134358005 | Justin D. Brown | Nurse Practitioner | 7900 W Jefferson Blvd, Suite 201, Fort Wayne, IN 46804-4128 | 2009-07-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396350344 | Derek Mumaw | Physical Therapist | 8420 Illinois Rd, Fort Wayne, IN 46804 | 2020-09-15 |
| 1942840228 | Erin M Mason | Behavior Technician | 5601 Coventry Ln, Fort Wayne, IN 46804 | 2020-01-14 |
| 1346880879 | Emily A Abdalla | Behavior Technician | 5601 Coventry Ln., Fort Wayne, IN 46804 | 2020-01-13 |
| 1083265433 | Fort Wayne Endodontics | Dentist | 9407 Illinois Rd, Fort Wayne, IN 46804 | 2019-09-26 |
| 1689140949 | Harrison Dental Group II, LLC | Dentist | 1333 Getz Rd, Fort Wayne, IN 46804 | 2018-10-15 |
| 1346731908 | Erin Nicole Zimmerman | Nurse Practitioner | 10170 Illinois Rd # 14, Fort Wayne, IN 46804 | 2018-05-19 |
| 1417446022 | Mary Harrington | Physical Therapist | 3320 Copper Hill Run, Fort Wayne, IN 46804 | 2018-05-09 |
| 1942701214 | Joshawa Todd Torres | Marriage & Family Therapist | 5651 Coventry Ln # 116, Fort Wayne, IN 46804 | 2018-02-22 |
| 1194235408 | Mitchell Kory Meyer | Specialist/Technologist | 9125 Yellow Tree Ct, Fort Wayne, IN 46804 | 2017-10-02 |
| 1902324916 | Emily Rene Sagstetter | Specialist/Technologist | 6034 Liberty Glade Ct, Fort Wayne, IN 46804 | 2017-08-30 |
| Find all providers in zip 46804 | ||||
| Taxonomy Code | 332B00000X |
| Grouping | Suppliers |
| Classification | Durable Medical Equipment & Medical Supplies |
| A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient’s use in the home and that are usable for an extended period of time. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487261897 | J & Y Medical LLC | Durable Medical Equipment & Medical Supplies | 227 E Dupont Rd, Fort Wayne, IN 46825-2047 | 2020-09-29 |
| 1023658283 | Genoa Healthcare, LLC | Durable Medical Equipment & Medical Supplies | 436 E Washington Blvd Ste P, Fort Wayne, IN 46802-3210 | 2020-01-15 |
| 1972036481 | Darah Medical Equipment and Supplies LLC | Durable Medical Equipment & Medical Supplies | 4206 Flagstaff Cv, Fort Wayne, IN 46815-4417 | 2017-04-11 |
| 1558749408 | Genoa Healthcare, LLC | Durable Medical Equipment & Medical Supplies | 2100 Goshen Rd Ste 111, Fort Wayne, IN 46808-1493 | 2015-05-12 |
| 1679979363 | Apsco | Durable Medical Equipment & Medical Supplies | 3710 Piper Dr, Fort Wayne, IN 46809-3121 | 2014-11-07 |
| 1720404577 | James Medical Rents & Sales, Inc. | Durable Medical Equipment & Medical Supplies | 7107 W Jefferson Blvd, Fort Wayne, IN 46804-6235 | 2014-03-17 |
| 1356772396 | Alexander James Medical Supply | Durable Medical Equipment & Medical Supplies | 2200 Lake Avenue, Suite 290, Fort Wayne, IN 46805 | 2013-12-02 |
| 1043658701 | Hook Superx LLC | Durable Medical Equipment & Medical Supplies | 4225 Hobson Rd, Fort Wayne, IN 46815-4506 | 2013-06-04 |
| 1811232614 | Meijer Stores Limited Partnership | Durable Medical Equipment & Medical Supplies | 1515 Profit Dr, Fort Wayne, IN 46808-1172 | 2012-12-05 |
| 1174893978 | Meijer Stores Limited Partnership | Durable Medical Equipment & Medical Supplies | 10301 E State Road 37, Fort Wayne, IN 46835-9591 | 2012-01-10 |
| Find all providers in FORT WAYNE | ||||
| City | FORT WAYNE |
| Zip Code | 46804 |
Please comment or provide details below to improve the information on SPINE SPORTS AND PAIN MEDICINE, PC.
| 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.