# ACTIVE ATHLETE SPORTS MEDICINE PSC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1699920272
- **Authorized official:** MRS. TRICIA ROBERTS (MANAGER)
- **Authorized official phone:** (812) 949-3482

## Contact information

- **Practice address:** 3891 CHARLESTOWN RD, NEW ALBANY, IN 47150-9562
- **Practice address phone:** (812) 949-3482
- **Practice address fax:** (812) 812-9418
- **Mailing address:** 3891 CHARLESTOWN ROAD, NEW ALBANY, IN 47150
- **Mailing address phone:** (812) 949-3482
- **Mailing address fax:** (812) 812-9418

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QS0010X | Sports Medicine (Family Medicine) Physician | 01033436A | IN | Yes |

## Other

- **Enumeration date:** 11/24/2008
- **Last updated:** 02/24/2009