Organization
ICE20 - TRIAD SPORTS GROUP, LLC
Active
Parent organization
TRIAD SPORTS GROUP, LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
TRIAD SPORTS GROUP, LLC
Authorized official
BRAD L SMITH (DIVISION PRESIDENT)
(805) 857-4172
Entity
Organization
Contact information
Practice address
4690 CALLE QUETZAL, CAMARILLO, CA 93012-8558
(805) 857-4172
Mailing address
4690 CALLE QUETZAL, CAMARILLO, CA 93012-8558
(805) 857-4172
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
12/31/2009
Last updated
10/07/2014
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