# MICHAEL ROSS SPORTS MEDICINE

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

## Provider details

- **NPI number:** 1902043565
- **Authorized official:** DR. MICHAEL JORDAN ROSS M.D. (PRESIDENT)
- **Authorized official phone:** (610) 952-6452

## Contact information

- **Practice address:** 1159 MORRIS RD, WYNNEWOOD, PA 19096-2236
- **Practice address phone:** (610) 952-6452
- **Practice address fax:** (484) 412-8385
- **Mailing address:** 1159 MORRIS RD, WYNNEWOOD, PA 19096-2236
- **Mailing address phone:** (610) 952-6452
- **Mailing address fax:** (484) 412-8385

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | MD430033 | PA | Yes |

## Other

- **Enumeration date:** 01/19/2009
- **Last updated:** 01/19/2009