Organization
SPORTS MEDICINE GRANT, INC
Active
Organization
SPORTS MEDICINE GRANT, INC
Active
Other names
Sports Medicine Grant & Orthopaedic Associates
Organization subpart
No
Provider details
NPI number
Authorized official
RAYMOND J TESNER MD (PRESIDENT)
(614) 461-8174
Entity
Organization
Contact information
Practice address
323 E TOWN ST, COLUMBUS, OH 43215-4774
(614) 461-8174
(614) 461-9155
Mailing address
323 E TOWN ST, COLUMBUS, OH 43215-4774
(614) 461-8174
(614) 461-9155
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0697974
—
OH
01
—
CD7823
OH RR MDCR (GROUP)
OH
01
—
CK2955
WV RR MDCR (GROUP)
WV
01
—
SP9213476
WV MEDICARE GROUP
WV
Enumeration date
12/09/2005
Last updated
02/22/2010
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