Organization
ST. VINCENTS SPORTS PERFORMANCE
Active
Organization
ST. VINCENTS SPORTS PERFORMANCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL TIMOTHY SAHM ATC/LAT (ATHLETIC TRAINER)
(317) 787-8277
Entity
Organization
Contact information
Practice address
8227 NORTHWEST BLVD, SUITE 160, INDIANAPOLIS, IN 46278-1387
(317) 415-5795
Mailing address
8227 NORTHWEST BLVD, SUITE 160, INDIANAPOLIS, IN 46278-1387
Taxonomy
Speciality
Code
Description
License number
State
284300000X
Special Hospital
Primary
36000279A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
36000279A
2255A2300X-SPECIALIST/TECHNOLOGIST- ATHLETIC TRAINER
IN
Enumeration date
08/10/2012
Last updated
08/10/2012
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