Organization
PURDUE SPORTS MEDICINE WL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOAN M VAUGHAN (HIPAA PRIVACY OFFICER)
(765) 496-1927
Entity
Organization
Contact information
Practice address
900 JOHN R WOODEN DRIVE, MACKEY ARENA, WEST LAFAYETTE, IN 47907
(765) 494-3245
(765) 494-9899
Mailing address
601 STADIUM MALL DR, WEST LAFAYETTE, IN 47907-2052
Taxonomy
Speciality
Code
Description
License number
State
207RS0010X
Sports Medicine (Internal Medicine) Physician
—
—
2251X0800X
Orthopedic Physical Therapist
Primary
—
—
2255A2300X
Athletic Trainer
—
—
Other
Enumeration date
09/16/2014
Last updated
10/24/2014
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